The pressures to increase Same Day Discharge utilization for PCI
October 12, 2020
Despite numerous, supportive scientific studies published in peer-reviewed journals over the past four years, coupled with the 2018 consensus statement issued by the Society of Coronary Angiography and Intervention, the adoption of same-day discharge (SDD) for PCI remains low in most hospitals in the U.S. Similarly, the adoption of transradial access varies greatly from operator to operator and program to program. Better safety, lower costs, and better patient experience don’t seem to be enough incentive to compel the shift. Two questions emerge: (1) Why the low and variable adoption level, and (2) What internal and external pressures might it take to get SDD and transradial to a predominant level of adoption?
Why? I think inertia and the adage “old habits are hard to break” can help explain the slow adoption. Left to individual operator’s discretion, we may continue to experience a slow rate of adoption year-over-year. The fact is that most PCIs are performed by operators who were trained to use transfemoral access and keep patients overnight. It is, very simply, their comfort zone. With no other environmental reasons to change (e.g. financial incentives that reward cardiologists for quality improvement, cost reduction and improved patient experience), why should these physicians proactively move away from what they know best and feel most comfortable with?
Pressures to change? In light of the persistent resistance to change, let’s consider the current state of cardiac programs and cath lab operations around the U.S. COVID-19 has wreaked havoc on most programs. Even though elective cases are starting to return to normal, most CV programs are still significantly behind 2020 budget levels. As I have said before, COVID-19 is a wake-up call for CV programs. It has served as a stress test and has exposed programmatic weaknesses. Prior to COVID-19 hitting we were under pressure to move away from fee-for-service and adopt value-based reimbursement. This shift and pressure will continue. Lastly, to make matters even more interesting, we are experiencing a wave of new “cardiovascular ASCs” all across the U.S., partially triggered by Medicare’s decision to cover PCI services performed in an ASC. Hospitals and the private equity market realize the huge potential in shifting cath lab procedures (cardiac and vascular) out of the hospital and into the lower-cost ASC setting. It is happening and the trend will pick up steam over the next few years.
The financial and strategic pressures are compelling. If a hospital’s CV program is going to survive long-term, the administrative and cardiologist leaders affiliated with that program must embrace the need to change, to lower costs, to improve throughput, and, in some cases, to compete with local and regional ASCs offering better patient experience and cost-savings to payers. SDD with transradial access is a fundamental and essential building block of that change, cost-reduction, throughput improvement and competitive positioning. It is time for accelerated adoption. Fortunately, there are companies like Terumo leading the way to help physicians and hospitals understand and facilitate the necessary operational changes that will deliver better economics, quality and performance measurements that are critically necessary as we migrate through and out the back end of this COVID experience.
About the Author
TIMOTHY W. ATTEBERY
DSc, MBA, FACHE
Contact: Twitter @TimAttebery
Former Chief Executive Officer (CEO) of the American College of Cardiology (ACC); former CEO of MedAxiom, an ACC company. Prior to leading the ACC, Tim was the CEO of Holston Valley Medical Center and both a previous CVSL and CV Practice leader.