Does Your Cath Lab Need a Tune-up or an Overhaul?
Thursday, June 8, 2017 | Larry Sobal
Once a virtually guaranteed high-profit center for hospitals, many cath labs are seeing their margins decline despite growing patient panel sizes. This can be due to a number of factors, but clearly there are some labs that seem caught in a time warp, and are doing many things the same way they did 10 or more years ago regarding processes, patient flow, etc. Introducing TAVR, PFO, CTO, Watchman and other new procedures and technology only exacerbates the inefficiency.
It’s no wonder there is increased scrutiny of cath lab performance. Add to that the CMS Cardiovascular Episode Payment Model initiative scheduled to begin January 1st, which includes AMI with PCI as part of the 90 day episode cost, as well as a rapidly evolving set of new procedures and subspecialists doing cases in the cath lab, and there has never been a greater need for organizations to make sure their invasive, interventional and EP programs are operating at high efficiency.
The question is: Does your cath lab have the administrative and physician leadership, tools, processes and actionable information necessary to achieve optimal clinical outcomes, improve operational efficiencies, increase patient satisfaction, drive down costs, provide an attractive work environment for physicians and staff, and improve profit margins? Our experience at MedAxiom indicates that is not always the case (see my blog from earlier this year Where your heart program is leaving big money on the table). Often, when MedAxiom conducts a cath lab assessment and care pathway development, we find $1 million or more of opportunity.
For many cath labs, it’s not unusual for most of their improvement energy to be focused on supply cost reduction. But at some point, there are diminishing returns of what savings you can earn from vendors, and you inevitably need to move on to reengineering workflows and processes. However, before you attempt to tackle those challenges, I first suggest you focus on optimizing physician alignment, and there is no better place to start than by working to ensure that there is a strong dyad relationship between the cath lab administrative director and the medical director.
Capturing all of your optimization opportunities cannot occur without alignment. But how do you know if you have a strong dyad relationship with aligned thinking? To start, I suggest you begin by completing a brief cath lab dyad survey designed to highlight how provider and administrative priorities align and/or differ. After completing the 10-minute survey you will receive your customized facility report that explains how you compare to other cath labs across the country. The survey will capture important data such as:
- Level of preparedness for new alternative payment models
- Radial volumes
- Level of transparency regarding individual physician costs
- Infrastructure to both review and take action on data
- Same-day discharge percentages of outpatient procedures
Popular options for cath lab optimization include building radial programs and initiating a same-day discharge program for them.
So let’s talk about where our cath lab assessments are finding $1 million+ opportunities. Popular options for cath lab optimization include building radial programs and initiating a same-day discharge program for them. The decision to move forward on any of these initiatives will certainly add value to an existing cath lab program by:
- Promoting safety through evidence-based care
- Driving standardization
- Expanding the care team beyond the procedural room
- Generating throughput
- Improving the experience for the team and the patient
- Increasing financial benefit
- Preparing the procedural area for future payment changes
However, your opportunities don’t stop there and include a need to thoroughly assess the following:
- Pre-operative diagnostic and care planning — ensure patient education is comprehensive and work meets appropriate use criteria
- Appropriate use of drugs and devices
- Discharge planning — medication education and timely follow-up appointments
- Care transition support — consider care coordinators for a consistent point of contact
- Post-acute care — cardiac rehab and other behavioral support programs
In particular, you need to fully understand your current state and design any improved future state regarding your intra-procedure workflows/processes:
- Dedicated scheduling/Commitment to fully fill schedule
- Provider and staff resource management
- Efficient room utilization and turnover
- Leverage the cath lab procedure log
If your cath lab is no longer meeting its financial expectations, is requesting new FTEs, has gaps and inconsistencies in patient readiness for procedures, has conflicting patient information, and struggles with on time start delays, it may need more than just a tune up—it may need an overhaul. And, there has never been a better time to do that.
Illustration: Lee Sauer
Larry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.
About the Author
Larry Sobal, MBA, MHA, is CEO of a yet-to-be-named cardiology practice which is transitioning from employment to an independent physician group effective January 1, 2019. He has a 37-year background as a senior executive in physician practices, consulting, medical group leadership, hospital leadership and health insurance.
To contact, email: firstname.lastname@example.org