AV Access Centers: Do they Make a Difference

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AV Access Centers Do they Make a Difference

• Krishna Jain MD, John Munn MD, Mark Rummel MD,
  Sarat Vaddineni MD
• Vascular Annual Meeting
• 6/4/2008

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Decline in Payment

• Over the last several years there has been
  progressive decline in payments for vascular
  procedures
• DRA of 2005 reduced vascular lab reimbursement
  between 18 and 51.
• Overall negative impact has been calculated to be
  5 in a vascular practice

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Challenges

• Poor reimbursement for professional component
• Poor time management
• Poor patient care
• Expensive care in hospital
• Changing referral patterns

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Challenges

• Revenue Decline
• Increased cost of running practice
• Other specialties taking our patients
• Interventional radiologists
• Interventional cardiologists
• Interventional nephrologists

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Challenges

• Majority of AV access centers are being run by
  interventional nephrologists
• The Dialysis companies are supporting the centers
  run by interventional nephrologists.
• Interventional nephrologists have almost no
  endovascular training
• Few centers are run by Interventional
  radiologists
• Very few centers are run by vascular surgeons

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Solution

• Own your imaging, access and venous center

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Benefits

• Own your dialysis access so that you can keep it
  functional for the longest period of time
• Do the right procedure
• Increase your revenue
• Control your schedule
• Improve your life style
• Increase productivity

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Diversity

• Vascular surgeons can use the facility and
  equipment to do more than access procedures.

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Procedures

• Arteriogram
• Venogram
• Insertion and removal of catheters
• Thrombectomy
• Fistulogram
• Angioplasty of dialysis access
• Insertion of coils
• Angioplasty and stent placement in peripheral
  arteries
• EVLT
• Microphlebectomy
• Sclerotherapy and Laser therapy
• Noninvasive lab

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Kalamazoo Experience

• In the first year of our operation we have
  performed 1041 procedures in the access center.
• 30 of procedures in our practice are carried out
  in our office.
• By year 2010 we project 50 of cases in the
  office
• These do not include Sclerotherapy, laser for
  spider veins and noninvasive testing

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Distribution of cases

• Arterial 15
• Venous 14
• Dialysis Access 43
• Catheter 27
• Venogram 1

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Cancellation of Cases

• 2 cases in one year
• Heart block
• Cardiac arrhythmia

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Results

• Mortality 0
• Morbidity 2.1
• Hospital admission 0.3

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Results

• Our catheter rate is 4
• 8-10 cases can be performed in one 8 hour shift

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Results

• Patient Satisfaction is 100

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Revenue
Procedure Office Hospital Office cost
Arteriogram Extremity 956.00 157.00 453.00
Aortogram 1582.00 272.00 453.00
CV catheter insert 941.00 350.00 295.00
CV catheter removal 165.00 138.00 25.00
EVLT with 10-20 stabs 2188.00 774.00 278.00
EVLT with gt20 stabs 2276.00 863.00 278.00
EVLT 1748.0 334.00 181.00
Fistulogram 639.00 185.00 245.00
Fistulogram with coiling 3035.00 1203.00 350.00
Stent 3042.00 524.00 1000.00
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Revenue
Fistulogram with Thrombectomy and 2 PTA 4855.00 1413.00 588.00
Fistulogram with PTA 2858.00 487.00 425.00
Venogram unilateral 393.00 80.00 147.00
Venogram bilateral 547.00 126.00 178.00
Microphlebectomy 10-20 incisions 440.00 440.00 127.00
Microphlebectomy gt20 incisions 529.00 529.00 140.00
Totals 26194.00 7875.00 5166.00
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Personal gains

• Despite the Medicare cuts we are able to maintain
  and enhance our income
• Fewer cases are being done in the hospital during
  off hours.
• Practice is growing because referring physicians
  are happier
• Families are happier because we are home earlier.

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Economics of Vascular Practice
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Economics of Vascular Practice
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Economics of Vascular Practice
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• The sooner you do it the sooner you will be
  happier
• Control your destiny

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It is a new dawn