title: Lower extremity endovascular interventions: can we improve cost-efficiency?
abstract: OBJECTIVE
  Management of lower extremity arterial disease with endovascular intervention is on the rise. Current practice patterns vary widely across and within specialty practices that perform endovascular intervention. This study evaluated reimbursement and costs of different approaches for offering endovascular intervention and identified strategies to improve cost-efficiency.
  
  
  METHODS
  The medical records of all patients admitted to a university health system during 2005 for an endovascular intervention were retrospectively reviewed. Procedure type, setting, admission status, and financial data were recorded. Groups were compared using analysis of variance, Student t test for independent samples, and chi2.
  
  
  RESULTS
  A total of 296 endovascular interventions were completed, and 184 (62%) met inclusion criteria. Atherectomy and stenting were significantly more costly when performed in the operating room than in the radiology suite: atherectomy, dollars 6596 vs dollars 4867 (P = .002); stent, dollars 5884 vs dollars 3292, (P < .001); angioplasty, dollars 2251 vs dollars 1881 (P = .46). Reimbursement was significantly higher for inpatient vs ambulatory admissions (P < .001). Costs were lowest when the endovascular intervention was done in the radiology suite on an ambulatory basis and highest when done as an inpatient in the operating room (dollars 5714 vs dollars 12,278; P < .001). Contribution margins were significantly higher for inpatients. Net profit was appreciated only for interventions done as an inpatient in the radiology suite. Reimbursement, contribution margins, and net profit were significantly lower among private pay patients in both the ambulatory and inpatient setting. The 30-day hospital readmission after ambulatory procedures was seven patients (6%).
  
  
  CONCLUSIONS
  Practice patterns for endovascular interventions differ considerably. Costs vary by procedure and setting, and reimbursement depends on admission status and accurate documentation; these dynamics affect affordability. Organizing vascular services within a hub will ensure that care is delivered in the most cost-efficient manner. Guidelines may include designating the radiology suite as the primary venue for endovascular interventions because it is less costly than the operating room. Selective stenting policies should be considered. Contracts with private insurers must include carve-outs for stent costs and commensurate reimbursement for ambulatory procedures, and Current Procedural Terminology (CPT; American Medical Association, Chicago, Ill) coding must be proficient to make ambulatory endovascular interventions fiscally acceptable.
authors.affiliation: Kaleida Health, Buffalo, NY, USA.
authors.forename: Monica S
authors.initials: MS
authors.lastname: O'Brien-Irr
authors.forename: Linda M
authors.initials: LM
authors.lastname: Harris
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Dosluoglu
authors.forename: Merril
authors.initials: M
authors.lastname: Dayton
authors.forename: Maciej L
authors.initials: ML
authors.lastname: Dryjski
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics; D017130:Angioplasty / Q000191:economics; D017073:Atherectomy / Q000191:economics; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D006282:Health Personnel / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007297:Inpatients; D007349:Insurance, Health, Reimbursement; D035002:Lower Extremity / Q000098:blood supply*; D009873:Operating Rooms / Q000191:economics; D010359:Patient Readmission / Q000191:economics; D016491:Peripheral Vascular Diseases / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000191:economics; D016730:Program Development; D011872:Radiology Department, Hospital / Q000191:economics; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000191:economics* / Q000458:organization & administration; D000078329:Workforce