Key result
Emergency department activation and immediate transfer for STEMI patients reduced hospital revenue from $35,043 to $25,329 and total hospital costs from $28,082 to $18,195, leaving net income unchanged.
Why the study?
Does a protocol for ED activation and immediate transfer to reduce door-to-balloon time impact hospital revenues, costs, and net income in STEMI patients?
Cohort (n=132)
No
Does a protocol for ED activation and immediate transfer to reduce door-to-balloon time impact hospital revenues, costs, and net income in STEMI patients?
Absolute Event Rate: 25329% vs 35043%
p-value: p=0.039
Reducing door-to-balloon time in STEMI patients significantly decreases both hospital costs and revenues, resulting in neutral net income for the hospital while payers reap the financial benefits.
ED activation for STEMI linked to neutral net hospital income; observational data leave open broader financial and outcome effects.
BACKGROUND: The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown. METHODS: We prospectively determined the impact on hospital finances of (1) emergency department physician activation of the catheterization lab and (2) immediate transfer of the patient to an immediately available catheterization lab by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected financial data for 52 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention from October 1, 2004-August 31, 2005 and compared this group to 80 consecutive ST-elevation myocardial infarction patients from September 1, 2005-June 26, 2006 after protocol implementation. RESULTS: Per hospital admission, insurance payments (hospital revenue) decreased ($35,043 +/- $36,670 vs. $25,329 +/- $16,185, P = 0.039) along with total hospital costs ($28,082 +/- $31,453 vs. $18,195 +/- $9,242, P = 0.009). Hospital net income per admission was unchanged ($6962 vs. $7134, P = 0.95) as the drop in hospital revenue equaled the drop in costs. For every $1000 reduction in total hospital costs, insurance payments (hospital revenue) dropped $1077 for private payers and $1199 for Medicare/Medicaid. A decrease in hospital charges ($70,430 +/- $74,033 vs. $53,514 +/- $23,378, P = 0.059), diagnosis related group relative weight (3.7479 +/- 2.6731 vs. 2.9729 +/- 0.8545, P = 0.017) and outlier payments with hospital revenue>$100,000 (7.7% vs. 0%, P = 0.022) all contributed to decreasing ST-elevation myocardial infarction hospitalization revenue. One-year post-discharge financial follow-up revealed similar results: Insurance payments: $49,959 +/- $53,741 vs. $35,937 +/- $23,125, P = 0.044; Total hospital costs: $39,974 +/- $37,434 vs. $26,778 +/- $15,561, P = 0.007; Net Income: $9984 vs. $9159, P = 0.855. CONCLUSION: All of the financial benefits of reducing door-to-balloon time in ST-elevation myocardial infarction go to payers both during initial hospitalization and after one-year follow-up. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT00800163.
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Khot et al. (2009) conducted a cohort in ST-elevation myocardial infarction (n=132). Emergency department physician activation of the catheterization lab and immediate transfer vs. Routine transfer (Cardiology Activation) was evaluated on Insurance payments (hospital revenue) per hospital admission (p=0.039). Emergency department activation and immediate transfer for STEMI patients reduced hospital revenue from $35,043 to $25,329 and total hospital costs from $28,082 to $18,195, leaving net income unchanged.
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