title: Peripheral occlusive disease may provide the highest hospital margins despite rising costs.
abstract: OBJECTIVE
  The objective of this study was to review vascular surgical financial trends in a tertiary care setting and to evaluate the impact of a vascular program within a health care system in the face of lower reimbursements and rising costs.
  
  
  METHODS
  With use of Current Procedural Terminology codes and diagnosis-related groups, vascular categories of aortic disease, cerebrovascular disease, and peripheral occlusive disease (POCD) were identified at an academic tertiary health care center. Hospital margins were calculated for each of the defined categories by Health Quest cost accounting data cross-walked with Current Procedural Terminology codes, date of service, and admitting physician for each year from 2010 to 2012.
  
  
  RESULTS
  All categories realized volume growth and a positive margin for the hospital. In comparison of 2010 and 2012, aortic cases showed an overall volume growth of 19%, revenue increase of 31%, and cost increase of 54%, resulting in an overall margin decrease of 7%. Cerebrovascular cases showed a 30% increase in volume growth, revenue increase of 13%, and cost increase of 5%, resulting in a margin increase of 18%. POCD cases showed overall volume growth of 35%, revenue increase of 37%, cost increase of 54%, and a margin increase of 15%. The margin for POCD exceeded the margin for aortic and cerebrovascular cases combined by 77%.
  
  
  CONCLUSIONS
  In evaluating a vascular program's fiscal viability, volume-driven POCD was the only category producing growing hospital margins in the face of significant cost increases.
authors: Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pa.
authors: Nadia
authors: N
authors: Awad
authors: Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, NJ. Electronic address: lombardi-joseph@cooperhealth.edu.
authors: Joseph V
authors: JV
authors: Lombardi
authors: Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, NJ.
authors: Jeffrey P
authors: JP
authors: Carpenter
authors: Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, NJ.
authors: Jose
authors: J
authors: Trani
authors: Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, NJ.
authors: Francis
authors: F
authors: Caputo
authors: Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pa.
authors: Nyali
authors: N
authors: Taylor
mesh_terms: D001018:Aortic Diseases / Q000191:economics / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000191:economics / Q000601:surgery; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D039702:Current Procedural Terminology; D005102:Health Expenditures; D017721:Hospital Costs / Q000639:trends; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000191:economics* / Q000639:trends; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D015397:Program Evaluation; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000191:economics* / Q000639:trends