Building Revenue for Your Cath Lab

Supply Cost Reductions Supply cost reductions is probably the first thought that comes to mind when cost reductions are deemed necessary. Although supplies are still a good place to begin, they are no longer the great frontier of cost reductions. Cath labs have achieved significant cost savings by negotiating lower costs for stents, balloons and catheters. Yet this approach may no longer provide the results it has in the past. In order to get the best possible supply cost reductions, we may now need to consider other supply opportunities such as supply capitation agreements, dual or primary vendor relationships, and making large bulk purchases to obtain the price of the supplies you desire. Vendors are much more likely to provide you with greater discounts when they see and are provided with the ability to achieve a greater market share of sales in your cath lab. All of these will provide supply cost reductions, but importantly, you must also get the assistance and backing of your cardiologists if any of these options are to provide you with the optimum cost saving. Another very good area to reduce supply costs in the cath lab is contrast utilization. Although your cath lab monitors contrast utilization for QA purposes, working with your cardiologists to reduce contrast use can be substantial savings to your bottom line. Supply and Procedure Charge Masters One area often overlooked as a path to obtain increased revenues is your supply and procedure charge masters. Charge masters can provide optimum revenues, but can be a source of lost revenues as well. Insuring that supplies are properly identified and coded can make a difference of hundreds of dollars gained or lost. Staying abreast with the changes in CPT coding is also another very important area for revenue. Reviewing the CPT codes, making sure that your procedure codes are accurate and the proper ICD9 codes are designated, can mean the difference between a profitable procedure or a very costly and lost-revenue procedure. Although many hospital organizations have staff for coding and billing, we as administrators must take the time and effort to assure that processes are correct in order to obtain the appropriate revenues. Negotiation with Private Insurance Payers Reimbursements are, at times, out of our direct control (such with as Medicare DRGs), but for private insurance payers, this is not the case. Cath labs today are faced with exceptionally high-cost supplies such as drug-eluting stents, ICDs and pacemakers. Unlike with Medicare, however, we can negotiate carve outs, pass through, and pay for cost for these items. Again, many hospital organizations have specific departments or staff to work with insurance payers for these items, but as administrators, we need to work with those individuals or departments to insure that they understand these high-cost items and are working with payers to acquire the best possible payments to improve your bottom-line revenue. Grow Your Peripheral Vascular Procedures Increased revenues are not just the result of cost reductions, but also an increase of your cath lab procedure volumes. In order to achieve greater procedure volumes in your cath lab, we must look to other procedures, not just coronaries. Cath labs must be proactive and work with their organizations and cardiologists to enhance volumes though new procedures in the areas of endovascular and peripheral vascular therapies. These procedures, overall, are less costly to perform and provide a reimbursement compatible to coronary interventions. If your cath lab is performing these procedures now, then your efforts need to be focused on how to develop screening programs in order to increase growth for these procedures. Operational Efficiencies Operational efficiency is another opportunity to achieve cost reductions to improve your revenue. Areas such as patient throughput and cath lab procedure room turnover times will improve your cath lab operations and your revenue. The cath lab concern of getting the patient to the right place at the right time can be frustrating and increase cath lab overall costs. It may be helpful to perform a throughput analysis to determine if the processes are truly working and if not, what needs to be done to improve patient flow. A second area of throughput that can affect your cath lab efficiencies is post-cath patient care. Does your cath lab service have adequate post procedure capabilities or does the lack thereof increase your cath lab turnover times? Providing an efficient throughput, both in the cath lab and post operative areas, will increase your productivity, patient satisfaction and cardiologist satisfaction. With operational efficiencies come both cost reductions in staffing, and increased revenues though higher-procedure volumes. Embrace New Technology When Appropriate Lastly, keeping abreast of new technology will decrease your procedure times and provide the catalyst for future volume growth. New imaging capabilities such as the flat plate imaging systems will help cardiologist to obtain better images, thus reducing procedure times and cost of procedures. New technology, such as CTA and MRA for coronary diagnostics, is also being heavily discussed. There are many opinions on this new technology, but cath labs should be prepared for it to arrive. The truth is that this technology is indeed coming, and fast. Now is the time to prepare for the changes it will bring. As administrators, we must prepare our cath labs for this change and take advantage of the benefits offered when it does arrive. Cath lab technology and procedures are ever-changing in our world, and this is just another change for which we must be prepared. In summary, to improve revenues we must reduce operational costs, be creative in adopting new procedures, and increase efficiencies for the cath lab as well as the overall throughput for cardiovascular patients. To properly build revenue, cath labs must be prepared for the changes that are in our future and be ready to capitalize on them. Author Allen Miller can be contacted at allen.miller@jhhs.org

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