SCAI/ACVP Expert Consensus Statement Addresses CCL Economics

May 20, 2019—In Catheterization and Cardiovascular Interventions, James C. Blankenship, MD, et al published an expert consensus statement on cardiovascular catheterization laboratory (CCL) economics for the Society for Cardiovascular Angiography and Interventions (SCAI) and the Alliance of Cardiovascular Professionals (ACVP).

The statement is intended for any physician, administrator, or CCL staff member who desires a fundamental understanding of the finances and economics of CCLs in the United States. The statement's goal is to illuminate the general economic principles of CCL operations and provide details that can be immediately used by CCL leaders. The authors noted that the primacy of the principles of medical ethics is vitally important and that all professionals in the CCL must focus on patients' needs and consider how their actions will affect not only the patient they are treating at the time but also how they will affect others.

As summarized in SCAI's Catheterization and Cardiovascular Interventions, the SCAI/ACVP statement promotes the following key points:

• To be successful and financially viable under current payment systems, CCL physicians and managers must optimize the outcomes and efficiency of care by aligning CCL leadership, strategy, organization, processes, personnel, and culture.
• Optimizing a CCL's operating margin (profitability) requires maximizing revenues and minimizing expenses. CCL managers often focus on expense reduction; they should also pay attention to revenue generation.
• Expense reduction depends on efficiency (on‐time starts, short turnover time, smooth day‐to‐day schedules), identifying cost‐effective materials, and negotiating their price downward.
• Revenue optimization requires accurate documentation and coding of procedures, comorbidities, and complications. In fee‐for‐service and bundled payment reimbursement systems, higher volumes of procedures yield higher revenues.
• New procedures that improve patient care but are expensive can usually be justified by negotiating with vendors for lower prices and including the “halo effect” of collateral services that accompany the new procedure.
• Fiscal considerations should never eclipse quality concerns. High-quality CCL care that prevents complications, increases efficiency, reduces waste, and eliminates unnecessary procedures represents a win for patients, physicians, and CCL administrators.

In an SCAI press release announcing the publication, Dr. Blankenship, who chaired the writing group, commented, “Cath lab physician directors have a special opportunity and a special responsibility to align their labs’ operations with SCAI’s mission of saving and enhancing lives. This paper was written with the intent of helping them do just that.”