Kalamazoo Center for Medical Studies, Michigan State College of Human Medicine, Kalamazoo, MI, USA.
J Vasc Surg. 2010 Feb;51(2):509-13; discussion 513-4. doi: 10.1016/j.jvs.2009.09.056.
The practice of vascular surgery is under pressure from various specialties and payers. Our group started office-based procedures in May 2007. This article reports our study of the effect of this change on our case volume, office revenue, and the financial impact on the health care system.
Between May 1, 2006, and April 30, 2007 (period 1), and between June 1, 2007, and May 31 2008 (period 2), 3041 and 3351 cases, respectively, were performed. In period 1, only venous cases could be done in the office. Before arteriogram, serum levels of urea nitrogen and creatinine were obtained. The number of percutaneous cases done in the hospital and office setting was analyzed, and revenue was calculated based on the 2008 Medicare fee schedule for our region. Amputation and mortality rates at 30 days were documented. Hospital DRG payment schedule was obtained.
In period 1, 670 (22% of total) percutaneous procedures were performed compared with 1502 (44.8%) in period 2, a twofold increase. In period 1, 1.5% of total cases were done in the office compared with 31% in period 2. There was a fivefold increase in revenue from these procedures. No deaths or amputations occurred as a result of procedures performed in the office. No anesthesiologist's expense and minimal preprocedural expenses were incurred. Total payment by Medicare, DRG payment to the hospital, and the physician component were higher in all the cases.
A vascular surgery practice can benefit from office-based procedures. Procedures can be done safely. It results in an increase in the number of percutaneous procedures and revenue with a significant savings to the health care system. Surgeons can control their schedule. Every vascular surgeon should consider doing these procedures in office.
血管外科学的实践正受到来自各个专业和支付方的压力。我们的团队于 2007 年 5 月开始开展门诊手术。本文报告了我们对这种变化对手术量、门诊收入以及对医疗保健系统的财务影响的研究。
2006 年 5 月 1 日至 2007 年 4 月 30 日（第 1 期）和 2007 年 6 月 1 日至 2008 年 5 月 31 日（第 2 期）期间，分别进行了 3041 例和 3351 例手术。第 1 期只能在办公室进行静脉病例手术。在进行血管造影之前，获取血清尿素氮和肌酐水平。分析了在医院和门诊环境下进行的经皮手术数量，并根据我们地区 2008 年医疗保险费用表计算了收入。记录了 30 天内的截肢率和死亡率。获得了医院 DRG 支付时间表。
第 1 期共进行了 670 例（占总数的 22%）经皮手术，而第 2 期进行了 1502 例（占 44.8%），增加了两倍。第 1 期，办公室进行的手术占总手术的 1.5%，而第 2 期为 31%。这些手术的收入增加了五倍。办公室手术无死亡或截肢。无需支付麻醉师费用和最低的术前费用。所有病例中，医疗保险支付总额、DRG 向医院支付额和医生费用均较高。
血管外科学门诊手术可使手术量和收入增加，并显著节省医疗保健系统的费用。可以安全地进行手术。外科医生可以控制自己的手术时间。每位血管外科医生都应考虑在办公室进行这些手术。
