Economics of Chest Pain Centers:
What Really Matters?
James L. Field, MBA, DBAManaging Director
Cardiology Preeminence Roundtable
The Advisory Board Company
Washington, DC
Chest pain centers come in all shapes and sizes. Some are mere marketing ploys to attract incremental revenue. Others are impressive displays of organizational efficiency and clinical expertise. The most effective ED-based chest pain centers combine three key services: (1) immediate evaluation of chest pain, (2) accurate diagnosis of MI with protocols for rapid treatment, and (3) definitive rule out of MI for all but the lowest-risk patients.
In weighing the merits of a first-rate chest pain center, decision makers will confront a complex set of economic questions and issues. Financial analyses will be needed to frame the initiative and understand major components of the investment-return equation. Furthermore, the CFO will expect detailed financial documents as part of a chest pain center proposal. Yet decision makers should resist placing too much emphasis on studying dollars and cents; to my experience, financial calculations associated with chest pain centers are only marginally useful. More importantly, they miss the central point of these centers, which relates to quality and efficiency of care.
Attempting to assess the financial impact of a chest pain center under fee-for-service medicine is a difficult exercise. To begin, there are dozens of insurers to consider, each paying different levels of reimbursement. Direct hospital costs are often not known. Furthermore, there are complicated tradeoffs to be modeled. For example, a chest pain center may reduce hospital admissions (a negative under FFS), but are these admissions profitable? Will lost profit from reduced inpatient admissions be offset by an increase in ED-based rule outs? When all is said and done, financial analysis typically yields few firm answers, and the resulting uncertainty can overwhelm needed innovation and initiative.
The economic promise of chest pain centers lies beyond immediate revenue and profit, and relates to the issue of developing unique care capabilities. The chest pain concept, stripped to its core, is about expert patient triage, smart and efficient management of a critical subset of the ED population. To invest in a chest pain center, or to embrace its principles, is to make a commitment to providing the highest levels of cardiac care. It is this sort of institutional competence that engenders public and payor confidence, leading to economic well-being over time. What managed care companies ultimately desire is discriminating medicine-assurances that money is appropriately spent. The chest pain center can be one powerful means to this end.
Looking to the practical side of tomorrow's economic environment, ambivalence about chest pain admissions fostered by fee-for-service reimbursement should rapidly wane. As hospital per diem and case-rate payments are ratcheted down, inpatient rule outs beyond a single day are unlikely to be profitable. More significantly, the spread of capitation will make controlled access to inpatient beds an imperative for financial survival. Under this payment scheme, chest pain centers offer an invaluable and necessary resource, serving as a disciplined gatekeeper to inpatient cardiac beds.
Return to Index of Articles for Clinician;
Volume 14.4
- Faculty Listing 3
- Introduction: Community Message in Acute Myocardial Ischemia 4
- Concept of Community Chest Pain Centers in Emergency Departments 5
- Reawakening Awareness of the Importance of Prodromal Symptoms in the Shifting Paradigm to Early Heart Attack Care (EHAC) 7
- The Role of Emergency Medicine in the Future of American Medical Care: A Summary of the Josiah Macy, Jr, Foundation Conference 12
- From ACC/AHA Guidelines to Best Practice: Can "Acute MI Report Cards" Save Lives?Measuring Quality of Care for Patients With Cardiovascular Disease 16
- Improving Lay Responses to Cardiovascular Emergencies and the Potential of Shifting the Paradigm to Early Heart Attack Care 18
- National Survey of Chest Pain Centers Rationale and Potential Results 21
- Outpatient Rule-Out Myocardial Infarction in Observation Units 22
- Reducing Time to Thrombolytic Treatment 24
- Intervention Programs to Reduce Patient Delays in Acute Myocardial Infarction 29
- Public Education Using the Early Heart Attack Care Program Shawnee Mission Medical Center 31
- School Component: Early Heart Attack Care Program Development and Evaluation 33
- Educational Strategies to Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction 36
- Precipitating Factors in Acute Cardiovascular Disease 41
- Use of Myocardial Perfusion Imaging in the Emergency Department for Risk Stratification 44
- The Evolution of Chest Pain Centers: The Impact of Technological Advances on the Evaluation of Patients With Possible Acute Ischemic Coronary Syndrome 47
- Critical Pathways for Triage and Treatment of Chest Pain Patients in the Emergency Department 53
- Chest Pain Centers: An Emerging Model for the Emergency Evaluation of Chest Pain and Treatment of Acute Myocardial Infarction 56
- The Key to Success in the Chest Pain Emergency Department: The Observational Role of theNurse 59
- Triage in Moderate Risk Patients With Chest Pain: The Emerging Role of Real-Time Continuous ECG Monitoring 61
- Diffusion of Innovations: The Introduction and Impact of the Chest Pain Emergency
- Department and its Comparison to the Coronary Care Unit Development 64
- Economics of Chest Pain Centers: What Really Matters? 68
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