O'Brien-Irr Monica S, Harris Linda M, Dosluoglu Hasan H, Dayton Merril, Dryjski Maciej L
Kaleida Health, Buffalo, NY, USA.
J Vasc Surg. 2008 May;47(5):982-7; discussion 987. doi: 10.1016/j.jvs.2007.11.052. Epub 2008 Mar 4.
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.
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.
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%).
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.
采用血管内介入治疗下肢动脉疾病的情况正在增加。目前，在开展血管内介入治疗的不同专科以及同一专科内部，实际操作模式差异很大。本研究评估了提供血管内介入治疗的不同方法的报销情况和成本，并确定了提高成本效益的策略。
对2005年期间入住某大学医疗系统接受血管内介入治疗的所有患者的病历进行回顾性分析。记录手术类型、治疗地点、入院状态和财务数据。采用方差分析、独立样本的Student t检验和卡方检验对各组进行比较。
共完成296例血管内介入治疗，184例（62%）符合纳入标准。旋切术和支架置入术在手术室进行时的费用明显高于在放射科进行时：旋切术，6596美元对4867美元（P = 0.002）；支架置入术，5884美元对3292美元（P < 0.001）；血管成形术，2251美元对1881美元（P = 0.46）。住院患者的报销明显高于门诊患者（P < 0.001）。血管内介入治疗在放射科门诊进行时成本最低，在手术室作为住院患者进行时成本最高（5714美元对12278美元；P < 0.001）。住院患者的贡献利润率明显更高。仅在放射科作为住院患者进行的介入治疗有净利润。在门诊和住院环境中，自费患者的报销、贡献利润率和净利润均明显较低。门诊手术后30天内有7例患者（6%）再次入院。
血管内介入治疗的实际操作模式差异很大。成本因手术和治疗地点而异，报销取决于入院状态和准确的记录；这些因素影响了可承受性。在一个中心内组织血管服务将确保以最具成本效益的方式提供治疗。指南可能包括指定放射科为血管内介入治疗的主要场所，因为其成本低于手术室。应考虑选择性支架置入政策。与私人保险公司的合同必须包括剔除支架成本以及对门诊手术进行相应报销，并且必须熟练掌握现行手术术语（CPT；美国医学协会，伊利诺伊州芝加哥）编码，以使门诊血管内介入治疗在财务上可行。
