Comparative Data for Cardiac Catheterization Laboratory Operations

Elizabeth Harris, RN, MBA, Patricia Tyson, RN, MSA, Dan Ketter, BA and Susana Rangel, RN, Goodroe Healthcare Solutions, LLC, Atlanta, Georgia
Elizabeth Harris, RN, MBA, Patricia Tyson, RN, MSA, Dan Ketter, BA and Susana Rangel, RN, Goodroe Healthcare Solutions, LLC, Atlanta, Georgia
More than ever, catheterization laboratory managers need access to comparative benchmark data in order to keep pace with the rapidly changing healthcare environment. The following article is the third in a series featuring just such benchmark data from the Goodroe Healthcare Solutions Data Warehouse. Following are a selection of graphs and tables presenting cost and utilization data from more than 80 participating hospitals. Anti-Platelet Therapy Utilization Data The use of anti-platelet agents for all coronary interventions has gradually increased over the past 24 months, beginning with a baseline of 38% in second quarter, 2000. Utilization reached a plateau through the four quarters of 2001, remaining between 47% and 48%. An increase of 3% to 51% is noted for second quarter, 2002. This is largely attributed to the 6% increase with percutaneous transluminal coronary angioplasty (PTCA) procedures. Device Utilization Data The CathSource Operational program measures the average number of devices used per interventional patient encounter. Device utilization calculations include stents, balloons, atherectomy cutters, guide catheters, guidewires and miscellaneous devices. Device use during stent procedures has remained relatively stable for over two years, decreasing in the first two quarters of 2001, then rising back to an average of 5.41 in fourth quarter, 2001. Noticeable changes have occurred over the past year in the area of PTCA device usage. Historically, PTCA device use remained relatively flat (4.42“4.46; the average number of devices used per interventional patient encounter) for five quarters beginning in second quarter 2000. The beginning of the upward trend was first noted in Q3 2001, and has continued to climb through second quarter, 2002 to 4.79 devices. This represents an increase of approximately 6% device use over the past year. Increased cath lab costs can be correlated to both anti-platelet use and device utilization for PTCA procedures this year. Cost Data Case costs in the CathSource Operational program represent the direct expense incurred by the catheterization laboratory for a particular patient encounter. Components of case cost are: labor, devices, anti-thrombotic drugs, contrast and medical/surgical supplies. Single-vessel and multi-vessel interventions are defined according to the Centers for Medicare & Medicaid Services guidelines. The cost of all coronary and peripheral interventions has remained relatively stable for the past two years. These cases increased in costs slightly ($20) to an average of $3,100 per case in second quarter, 2002. Peripheral vascular case cost has been labile over the past eight quarters, with a reduction in cost of $100/case second quarter, 2002. The average cost of a PTCA procedure continued to rise significantly during second quarter, 2002, as it has done over the past year and a half. Since the fourth quarter of 2000, costs for these cases are up an average of $631, primarily due to higher device costs and the increased use of anti-thrombotics in this patient population. The average cost for all diagnostic cases continued to decline through the second quarter. The average cost of all electrophysiology (EP) cases remained relatively unchanged in second quarter, 2002, after increases for the past year ($801/case). Diagnostic EP cases experienced a $128 reduction in case costs in the second quarter to an average of $480 per case. After an increase in costs first quarter, RF Ablation has decreased significantly ($645) and is close to the fourth quarter mean. Pacemaker costs continue to fluctuate slightly to $6,629 in second quarter, 2002, an increase of $68 from the previous quarter. Average costs for implantable defibrillator have increased to $26, 319, the highest cost for this procedure in over a year. This increase in cost is largely attributed to a $750 increase in average device cost. It is interesting to note that increases in cath lab costs cannot be attributed to additional multi-vessel interventions. As noted in Figure 6, the percentage of multi-vessel (22%) and single vessel (78%) procedures has remained steady for the past year and a half. Bed Utilization Data Another interesting cost parameter to monitor is the placement of patients post cath lab procedure. There is an overall trend of increased use of the cath lab holding area and telemetry units. Also noted is the decreased use of critical care. Goodroe Healthcare Solutions offers a combination of clinical software and consulting services that help catheterization laboratories monitor a wide array of performance measures and use the data captured to make significant and lasting improvements in laboratory operations. Each quarter, more than 80 participating hospitals contribute approximately 50,000 patient encounters to the Goodroe Data Warehouse. In return, each facility receives a quarterly report that includes a detailed analysis of their performance and comparisons to national, volume-class and best-in-class benchmarks. For further information about the data presented in this article or to learn more about the CathSource Operational program, contact Goodroe Healthcare Solutions at 1-888-226-3001. You can also visit Goodroe on the Internet by pointing your browser to http://www.goodroe.com.