Revenue-Driving Cardio Subspecialties Thriving

Joe Cantlupe, for HealthLeaders Media , August 8, 2013

The 547-licensed-bed Ochsner Medical Center in New Orleans is focusing on such cardio repairs to capture a patient market, says J. Stephen Jenkins, MD, FACC, FSCAI, associate section head for interventional cardiology and director of the cardiac catheterization laboratory. "Everything is going to minimally invasive techniques," says Jenkins. "We repair aneurysms in a minimally invasive way that 10 or 15 years ago was done surgically."

Although some hospitals are moving tentatively with subspecialties, Spectrum's Wohns says "I don't think these are a passing fad because there is increased data on reduced cost and increased patient satisfaction, increased safety and fewer adverse events. I think the trends will continue as the story unfolds, with economic benefits, too."

Spectrum and other hospitals are investing millions of dollars in hybrid ORs, which are considered an ideal setting for minimally invasive procedures that require advanced imaging. Some hospitals are using the hybrid OR to pursue innovative cardio subspecialty procedures to treat patients who are too ill to undergo traditional surgery.  

One notable procedure is the transcatheter aortic valve replacement, or TAVR, says Zoltan Turi, MD, FACC, FSCAI, director of the structural heart disease program at the 493-bed Cooper University Hospital in Camden, N.J.

"Because we have access to TAVR, we have become a referral site for cardiologists who have patients they are reluctant to send to hospitals for surgery," Turi says. "The number of hospitals that use TAVR is growing. When we started, we were one of the first ones. Now there are more than 200 sites in the U.S."

The hybrid OR opens the door for such procedures.

The 442-staffed-bed St. Peter's Hospital in Albany, N.Y., is also high on hybrid ORs to improve outcomes and offer variety in cardiac care.  

"We do a tremendous number of endovascular procedures and have great outcomes. The robotic equipment allows us to visualize the reconstruction of the aorta through a synchronized imaging display," says Dorothy Urschel, MS, ACNP-BC, RNFA, NEA-BC, MBA, the cardiac and vascular service line director for St. Peter's Health Partners. Urschel says the hybrid ORs have enabled minimally invasive surgeries that typically require shorter lengths of stay and faster recovery than open procedures. "Many surgeries are going to be minimally invasive."

Over the years, hospitals have been buying more and more hybrid OR suites, with a 10% growth each year over the past two years, according to the ECRI Institute, a nonprofit organization based in in Plymouth Meeting, Pa., that researches healthcare cost-effectiveness.

There is growing market pressure on hospitals to have hybrid ORs, says Thomas Skorup, FACHE, vice president for applied solutions at ECRI, as more physicians want to perform new combinations of endovascular laparoscopic surgery or open procedures in the same OR with advanced angiography image guidance. Hybrid OR suites comprise up to 100 different medical devices and systems from multiple vendors, with key technologies such as a fixed angiographic imaging system.  

One of the major issues is cost. Hospitals leaders considering hybrid ORs must evaluate how they plan to use each 900- to 1,400-square-foot system in the surgical theater, and should expect hefty expenses involved, ranging from $3 million to $4 million for each suite. Because of the expense, the possibility for short-term ROI is questionable. Staff training and development are essential for the safety and efficiency of the hybrid OR, which is double the size of a standard OR, Skorup says.

 Hospitals need to evaluate purchasing, pricing, and the right imaging system to meet the different needs of their organizations, Skorup says.

"I've seen institutions making great investments in technology like the hybrid OR or cath lab or interoperative MRI," he says. There are some instances, however, where hospitals are saying, 'We aren't using them as much as we would have expected,' " Skorup says.

Success key No. 1: Amputation prevention programs

Every year, more than 100,000 adults lose limbs due to vascular disorders, and with an aging and increasingly heavier population at risk for diabetes, more are likely to do so. Most patients at risk of losing limbs are afflicted with peripheral arterial disease, a circulatory problem in which narrowed arteries reduce blood flow to the arms or legs.

The vascular amputation program at 208-bed Metro Health Hospital in Wyoming, Mich., has focused on improving circulatory care for patients and preventing amputations, even though some recommendations for amputation originated with patients' primary care physicians.

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