Hospital accepts loss for improving heart attack care:

April 9, 2007

St. Francis Hospital officials have found that improving care and cutting costs to treat heart attack patients comes at an unexpected price.

A new program cut the hospital's time to treat patients and reduced the size of the heart attack-saving $9,400 per admission. But reimbursement by insurance companies dropped $9,715, resulting in the hospital losing $315 per admission.

"The pay for quality and pay for performance issue under the current reimbursement structure is not designed to reward quality of care," said Umesh Khot, a heart doctor with the St. Francis Heart Center, who designed the program. "If you do something that reduces the cost of care, the system by design will pay you less."

The new program, which was implemented and tracked from September 2005 through June 2006, also reduced the patient's length of stay, Khot said. The program compared time to treat patients during the previous 11 months.

Khot's program, which was presented recently at the 56th Annual Scientific Session of the American College of Cardiology in New Orleans, charges the emergency room physician with determining the patient's heart attack risk. The doctor then informs the catheterization lab that a patient is coming and that the lab must prepare space.

In the past, an emergency room doctor would contact a cardiologist, who would evaluate the patient. Once examined, a patient sometimes had to wait for space to open in the hospital's cardiac catheterization lab for treatment.

National standards call for heart attack patients to be treated within 90 minutes, Khot explained. Prior to St. Francis implementing the new program, it averaged 113 minutes. The new program cuts that time by 38 minutes. The size of the heart attack was reduced by 40 percent and the length of stay fell two days, both as a result of the patient being evaluated sooner, Khot said.

"Traditionally, we're taught if you just move faster, you should get these people treated faster," Khot said. "But that doesn't really work. Parallel processing as opposed to serial processing is needed."

Regarding dollars lost with the new program, Khot says that shouldn't be a factor for other hospitals deciding to adopt their program. He expects they will.

"This points out the limitation of the current hospital reimbursement situation," he said. "Even if the drop in revenue had been greater, this is still the right treatment for patients."
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