Published Apr 14, 2014
Is anyone else experiencing a decrease in the number of cases per day in your Cath Lab? I work in what has always been a super busy interventional lab. With the insurance changes in beginning of this year, our numbers are down 30% for scheduled angiograms with possible angioplasty. Patients are told they need an angiogram after a positive stress test. They decide to hold off as they are uncertain what their coverage really is and how much the preventative procedure will cost. On the other hand our STEMI numbers have increased quite a bit. It appears that the same patient population is arriving as emergent STEMI cases when they possibly could have had preventative angioplasty. It is so frustrating to realize many of these STEMI patients could be the sad result of uncertainty about the new national insurance program.Is anyone else experiencing a decrease in the number of cases per day?
In our local hospital we have seen an increase in our cath cases as well as EP. We are a midsize community hospital but we are also at many local events in the community to spread the word about heart disease and interventions that can be done, be it plumbing or electrical. Our STEMI program is pretty much the same with high and low spots.
We have decreased Cardiac cases by 20%. Luckily we are increasing our Vascular, EP and Neuro cases. I'm not sure if its the newer insurance program or just tougher guidlenes from CMS regarding the need for Diagnostic Caths. CMS sets the standard for all insurance, private and social so I think that's the driving force for he decreased amount if heart caths. I'd like to see some studies in the near future re: cade amounts of diagnostics vs. STEMIs
What specific change are you referring to?
The only recent change to heart cath coverage was that the Physician reimbursement rate for interventional procedures was decreased 18% but that went into effect over a year ago and should be been much more of a cut. Physician reimbursement rates are based on the approximate time a procedure takes, and PCI's were still estimated to take about 4 hours, which today is a rather ridiculous amount of time since the real average is 30 to 45 minutes. CMS wanted to reduce it to 2 hours, and the cardiologists lobbying group managed to keep the estimate at 3.3 hours.
I'm not aware that there's been any specific cuts to diagnostic cath reimbursement or coverage for patients that would reduce the use of diagnostic caths.
Insurance deductibles and overall coverage is holding up a lot of procedures. Wonder how many of the emergent STEMI cases had positive nuclear studies and did not schedule a cath? In any event, it does seem cath cases fluctuate and just when you begin wondering where all the patient's are, they show up and you are slammed.
Firstly as far as reimbursement etc., each state is different. Medicare cuts to hospitals in some areas have been huge. Now even some of our very complex angioplasty patients are being discharged as day patients and that causes a decrease in income. Many more of our STEMI patients do state that they had a positive study ... but.... Their confusion about what the cost would be to them with the new National Health Coverage caused them to not schedule elective angiograms. Plus how many times have we all heard "I only had "SOB" or "The CP went away when I rested so I didn't think it was serious"? Our staffing and hours were cut because of the consistent decreased volume and other income issues. Now the volume has been running above our usual of 25+/- cases per day and call remains super busy. Staffing is stretched to the ultimate max with the volume of work, extra call and working late to finish the elective cases. So far everyone is hanging in there and hoping this consistent increase in the volume of care will be proof of our need to reinstate staffing and resolve the call issues. Sadly if this is not handled our wonderful history of a well season very experienced staff with almost no turn over may change in a big way.
State run medicare is medicaid. There have been no medicare cuts to hospitals under the ACA (Obamacare), medicaid coverage actually increased under Obamacare.
Determining what your coverage is hasn't changed at all, it's still the same private insurance plans we had before.
"New National Health Coverage"?
Please let me explain, I am not discussing cuts under the new National Health Care. This is Medicare's autocratic rating system that has penalized many large state hospitals as much as 35 million dollars/year. It your read the rating system it makes a certain amount of sense, but as we all know no matter how great the quality of care given, many patient's with multi-system issues are sadly going to unknowingly drag down the rated quality of care. In the main, this patient grouping does not respond to the evaluation polls concerning the quality of their provided care due to their heart breaking & overwhelming struggles just to get by. In states that do not have "for profit" hospitals, All hospital naturally must and willingly do treat every patients in need without question of cost or ability to pay. Add in that a large portion of any Medicare reimbursement is now is based greatly on the patient's evaluation of their care. Statistically this type of response is not well generated from this financially struggling population. The rating is also further lowered by the statistics the show many of these patients are admitted more than once for the same preventable DX because there is a major lack of awareness of the available assistance that is possible for regular no cost preventative health care. Thanks for listening!
You're referring to HCAHPS surveys, which is a component of value based purchasing. While it's certainly deserving of some criticism, I'm not sure how it reduces the number of people getting heart caths.
"Large state hospitals", including those that service a disproportionate number of poor and chronically ill patients actually due relatively well in these surveys. The ratings system is based on how a hospital compares to average, so while in general it is difficult to make patients happy, you don't actually have to make more patients happy to avoid reduced reimbursement, you only have to make your patients as happy as the average hospital does. It's just those who do a significantly worse job of patient care that get reduced reimbursements.
I am sincerely sorry to have given such a simple & incomplete explanation of the Medicare reimbursement that severely impacted numerous large hospitals in many states. As I've mentioned, the Medicare crisis hit my hospital when our when our Cath. Lab had a unusual decreased in case volume, thus when evaluating needed cutbacks the Lab appeared to be an accurate candidate. This followed the afore mentioned discontinued funding for traveling staff, a significant increased in all staff on call time, decreased hours in some cases and a changed difficult scheduling. As the National Health Care issues began to resolve our case load returned to normal volume and on most days it's well above our previous case levels. Now we work with a higher number of cases per day with a significantly decreased staff. Out staff is a very close group of, caring, highly experience and technically well trained staff with almost no turnover. The Department's Director is an incredible fiscal & staff manger who shares her concerns with our situation as do the Cardiologists. We all hope a bit more time of proven consistent volume will justify giving us relief from at least the extra call and tough scheduling. Any positive thoughts sent our way would be very much appreciated.
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