Abstract
BackgroundCardiac catheterization laboratories (CLL) have continued to function as profit centers for hospitals. Due to a high percentage of material and labor costs, they are natural targets for process improvement. Our study applied a contribution margin (CBM) concept to evaluate costs and cost dynamics over a 5-year period.MethodsWe retrospectively analyzed all procedures performed at a tertiary heart center between 2007 and 2011. Total variable costs, including labor time, material, and maintenance-expenses, were allocated at a global as well as a procedural level. CBM and CBM ratios were calculated by integration of individual DRG revenues.ResultsAnnual case volume increased from 1288 to 1545. In parallel, overall profitability improved as indicated by a 2% increase in CBM ratio and a higher CBM generated per hour of CLL working time (4325 vs. 5892 €, p < 0.001). Coronary angiography generated higher average CBMs per hour than coronary or electrophysiological interventions (5831 vs. 3458 vs. 1495 €; p < 0.001). The latter are characterized by relatively high per case material expenditures. On a procedural level, DRG-specific trends as a steady improvement of examination time or an increase in material costs were detectable.ConclusionsThe CBM concept allows a comprehensive analysis of CLL costs and cost dynamics. From a health service providers view, its range of application includes global profitability analysis, portfolio evaluation, and a detailed cost analysis of specific service lines. From a healthcare payers perspective, it may help to monitor hospital activities and to provide a solid data basis in cases where inappropriate developments are suspected. The calculation principle is simple which may increase user acceptance and thus the motivation of team members.Electronic supplementary materialThe online version of this article (doi:10.1186/s40001-016-0238-5) contains supplementary material, which is available to authorized users.
Highlights
Cardiac catheterization laboratories (CLL) have continued to function as profit centers for hospitals
Based on a detailed analysis of material and labor expenses, our study provided a contribution margin (CBM) analysis of typical cardiac catheterization laboratory (CCL) procedures over a 5-year period
Since there was no significant rise in average diagnosis-related groups (DRG) revenues between 2007 and 2011 (2842 ± 1615 vs. 2963 ± 1878 €; ns) and material expenditures (444 ± 591 vs. 476 ± 620 €; ns) remained unchanged, this improvement directly translated into a higher CBM per hour of CCL time (4325 ± 3937 vs. 5892 ± 5882 €; p < 0.001) and a 2% increase in CBM ratio (Table 1)
Summary
Cardiac catheterization laboratories (CLL) have continued to function as profit centers for hospitals. Cardiac catheterization laboratories (CCLs) are modern and technologically advanced facilities offering specialized care to patients with a wide range of cardiac and vascular disease They are frequently considered as profit centers within a hospital system [1]. Plehn et al Eur J Med Res (2016) 21:44 considered as an essential step to identify those procedures which contribute most to the coverage of hospital’s unavoidable fixed cost burden [10]. This applies to the management of operating rooms or CCLs where time constraints are common. Since CBM analysis requires data on the individual patient level, it is more complex and timeconsuming and was, infrequently used in the past [12]
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