ACVP Management Corner

Cath Lab 101: Ideas to Increase Your Bottom Line

Tim Kimball, Cardiology Director, Ozarks Medical Center West Plains, Missouri
Tim Kimball, Cardiology Director, Ozarks Medical Center West Plains, Missouri
With high volumes, cost and reimbursement, successful cardiology programs drive the revenue in the hospital. Declining reimbursement and increasing expenses make our jobs managing even tougher. During these tough economic times, we have to work hard to increase our bottom line. We have to consider all avenues in order to make money without sacrificing patient care. Where do you start? What do you watch? I can sum it up with one word: volume. Volume drives everything. It’s one of the few things we cannot control, yet it controls us. It’s something we must keep a very close eye on because it can help us in so many ways. Volume helps us predict our revenue, variable expenses, and labor, all very important pieces to the budgeting process. When we predict our volume accurately, the budget process becomes much friendlier. Start by tracking your workload units. It helps me to track the specific workload units driving heart caths, coronary intervention, peripheral procedures, peripheral intervention, implants, and miscellaneous procedures. If you did electrophysiology procedures (EP), that would be its own category as well. Take the time to track your workload units separately, because it helps identify and explain any variances that crop up throughout the year. You will be able to identify immediately why your revenue and/or expense was up or down for the month when you track your workload units separately. You will also build up historical data which will help you identify trends throughout the year. I track my stats in an Excel spreadsheet and have learned to love it. I knew nothing about Excel when I started in the cath lab, but quickly became familiar with the software. Most colleges provide basic and advanced courses for those people who do not like to experiment. Your finance department is also an excellent resource for Excel spreadsheets. My spreadsheets make the budget process a little easier, because I can quickly verify the data being sent by the finance department. The charge master is your friend. You need to become familiar with the coding process. Inaccurate coding leads to denials, which means even less reimbursement. If the charge goes in correctly on the front end (meaning you), there is less chance for coding errors on the back end (your coding department). It is your job to make sure the charge master is accurate. You need to verify that your CPT or HCPCS codes are accurate for the work you are doing. You also need to make sure that the correct mandatory device codes (C codes) are built and charged when you perform a procedure requiring one. If you are unfamiliar with anything that I have said, get with your coders. If you have your own coder coding all of your cardiology procedures, that is great, you are one step ahead. At a minimum, you should review the charge master yearly when the new CPT/HCPCS book is released. Craneware (Orlando, FL) is an online charge master revenue cycle management software for healthcare. It requires a subscription, but I have found it very helpful in keeping my charge master up to date. Once you have entered your charges, you got paid, right? Hopefully, but you need to make sure there was not a denial for some reason. There are many scenarios that could cause a denial to happen. Many times, it is the result of inaccurate coding or lack of supporting documentation. Whatever the reason, learn from it so you can prevent it from happening again. Work with your coding and billing departments closely so you can keep a watchful eye. Maintain your expenses. Easier said than done, I know, but it is a must. Start by looking at your big-ticket items, which means consignment. The different types of drug-eluting stents on the market can help you save money. Even for the low-volume lab, vendors are getting very aggressive with pricing to get their stents (and other consumables) on the shelf. You may be told that you can save the most by having only one vendor on the shelf. This is a false statement. You can get very aggressive pricing with little market share, thanks to variety. A new drug-eluting stent added to your shelf can also drive your pricing lower on your bare-metal stents, balloons, wires, catheters, introducers, and accessories. Believe me, I know from personal experience. I went from being a “sole-vendor” to a “multi-vendor,” and saved a lot of money. If you think you are paying too much, simply ask your representative to see if they can do better. A lot of times it is “yes,” but the worst that can happen is that they say “no.” Usually, an 80% market share for pacemakers and defibrillators will get you the best pricing. If you are not part of a group purchasing organization (GPO), get with your materials management department and see how you can benefit. GPOs work hard to save you money. They are constantly negotiating with vendors to get you the best pricing. After you have looked at your big-ticket items, look at your high-volume items. A few examples are cath packs, gloves (sterile and non-sterile), masks, hats, etc. Get with your representatives and make sure there is not a cheaper alternative that still promotes quality care. Often just by reviewing your inventory, you will find many items that can be reduced or eliminated. It takes some time, but it is well worth your effort. Your savings will add up if you take the time to find alternatives, reduce, and/or eliminate unnecessary supply. The most important factor is your patient. Be a patient advocate and make them your first priority. If you strive to keep your patients happy, you will have success no matter what. Tim Kimball can be contacted at