title: Elimination of medically unnecessary duplex venous scanning based on an established algorithm can result in significant cost savings under Medicare for the institution and the taxpayer.
abstract: OBJECTIVE
  The utility of duplex venous scanning (DVS) for suspected deep venous thrombosis in the emergency department (ED) remains controversial. We aimed to measure potential cost savings and economic impact in our institution and nationally for unnecessary DVS in Medicare patients seen in the ED.
  
  
  METHODS
  We have previously calculated that 15.3% of DVS studies can safely be avoided in patients with suspected deep venous thrombosis in our ED with adherence to our protocol. The Medicare database was queried for the number of DVS studies performed in the ED and charges/payments made in 2011. Cost savings at our institution and nationally by Medicare were computed with the 15.3% number.
  
  
  RESULTS
  In the study period, 2087 DVS studies were performed in our ED across all payers; 572 Medicare patients had 249 (43%) bilateral and 323 (57%) unilateral studies. Annual savings at our institution, with use of our protocol, were estimated at $113,778. Eliminating unnecessary after-hours DVS for 306,307 Medicare beneficiaries would result in $5,285,090 savings annually.
  
  
  CONCLUSIONS
  Increasing pressure for cost containment under a value-based payment model necessitates critical evaluation of resource utilization. Applying this schema for all noninvasive vascular tests is an opportunity for responsible management of finite resources, reducing wasteful care, and significant cost containment.
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Mouawad
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Go
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Mounir J
authors.initials: MJ
authors.lastname: Haurani
authors.affiliation: Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Moseley
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: bhagwan.satiani@osumc.edu.
authors.forename: Bhagwan
authors.initials: B
authors.lastname: Satiani
mesh_terms: D000465:Algorithms; D017046:Cost Savings; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D005102:Health Expenditures; D006801:Humans; D006278:Medicare; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics; D014481:United States; D014680:Veins / Q000000981:diagnostic imaging*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000191:economics*