Abstract
BackgroundThe impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown.MethodsWe prospectively determined the impact on hospital finances of (1) emergency department physician activation of the catheterization lab and (2) immediate transfer of the patient to an immediately available catheterization lab by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected financial data for 52 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention from October 1, 2004–August 31, 2005 and compared this group to 80 consecutive ST-elevation myocardial infarction patients from September 1, 2005–June 26, 2006 after protocol implementation.ResultsPer hospital admission, insurance payments (hospital revenue) decreased ($35,043 ± $36,670 vs. $25,329 ± $16,185, P = 0.039) along with total hospital costs ($28,082 ± $31,453 vs. $18,195 ± $9,242, P = 0.009). Hospital net income per admission was unchanged ($6962 vs. $7134, P = 0.95) as the drop in hospital revenue equaled the drop in costs. For every $1000 reduction in total hospital costs, insurance payments (hospital revenue) dropped $1077 for private payers and $1199 for Medicare/Medicaid. A decrease in hospital charges ($70,430 ± $74,033 vs. $53,514 ± $23,378, P = 0.059), diagnosis related group relative weight (3.7479 ± 2.6731 vs. 2.9729 ± 0.8545, P = 0.017) and outlier payments with hospital revenue>$100,000 (7.7% vs. 0%, P = 0.022) all contributed to decreasing ST-elevation myocardial infarction hospitalization revenue. One-year post-discharge financial follow-up revealed similar results: Insurance payments: $49,959 ± $53,741 vs. $35,937 ± $23,125, P = 0.044; Total hospital costs: $39,974 ± $37,434 vs. $26,778 ± $15,561, P = 0.007; Net Income: $9984 vs. $9159, P = 0.855.ConclusionAll of the financial benefits of reducing door-to-balloon time in ST-elevation myocardial infarction go to payers both during initial hospitalization and after one-year follow-up.Trial RegistrationClinicalTrials.gov ID: NCT00800163
Highlights
The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown
We recently showed that emergency department physician activation of the catheterization lab combined with a novel strategy of immediate transfer of the patient to an immediately available catheterization lab by in-house nursing staff reduces door-to-balloon time, leading to a reduction in myocardial infarct size and hospital length of stay [14]
Median door-to-balloon time decreased overall (113.5 minutes vs. 75.5 minutes, P < 0.0001), and treatment within 90 minutes increased from 28% to 71% (P < 0.0001)
Summary
The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown. The quality of health care by physicians and hospitals has received increasing interest due to well-documented deficiencies in the care delivered to patients [1]. This interest focused on public reporting of definitive outcomes such as mortality in patients undergoing coronary artery bypass grafting [2]. Interest in hospital quality reporting accelerated rapidly with implementation of the Hospital Quality Initiative by the Centers for Medicare and Medicaid Services (CMS) This program initially requested voluntary submission of 10 quality measures with the caveat that non-submission would result in a 0.4% decrease in Medicare payments. Participation in this program has been nearly universal with 99% of acute care hospitals submitting data to CMS, and the program has evolved to include submission of 21 quality measures with future plans for additional measures [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
