The Transition to Outpatient of Coronary Angioplasty (PTCA)

THE TRANSITION TO OUTPATIENT OF CORONARY ANGIOPLASTY (PTCA) Coronary angioplasty (PTCA) is a procedure to treat narrow or blocked carotid arteries, usually with the placement of a stent to keep the artery open. The procedure is on the leading edge of a growing trend in US hospitals of transitioning inpatient procedures to the outpatient setting. THE RESULT: LOWER COST OF CARE CORONARY ANGIOPLASTY IS SHIFTING FROM 1 DAY INPATIENT .CREATING ABOUT $2,100 IN BENEFIT, STAYS TO OUTPATIENT PROCEDURES... WHICH IS ALMOST ENTIRELY CAPTURED BY PAYORS $2,100 PERCENT OF TOTAL CORONARY ANGIOPLASTY WITHOUT COMPLICATIONS BY VOLUME 100- 90 - 3+ DAYS INPATIENT TOTAL SAVINGS PER CASE? 80 - >> 70 - 2 DAYS INPATIENT 60 - $100 - $2,000 50 - 1 DAY INPATIENT 40 - HOSPITALS BENEFIT FROM PAYORS BENEFIT FROM LOWER 30 - HIGHER PROFITS PER CASE REIMBURSEMENTS PER CASE 20 - OUTPATIENT 10 - 2008 2009 2010 2011 THERE IS OPPORTUNITY FOR THIS TREND TO CONTINUE AS 20% OF HIGH VOLUME PHYSICIANS HAVE NOT YET TRANSITIONED TO OUTPATIENT PERCENT OF PHYSICIANS WITH >100 CORONARY ANGIOPLASTY CASES PER YEAR; 2011 HIGHEST VOLUME PHYSICIANS 20% OUTPATIENT FOOTNOTE: SOURCES: OBJECTIVEHEALTH" 1. lod-9-cm primary procedure code 00.66 (percutaneous transluminal coronary angioplasty.) Ms-drg code 247 (percutaneous cardiovascular procedures with drug-eluding stent without moc) and 249 (percutaneous cardiovascular procedures with non-drug-eluding stent without mcc.) Objective Health de-identified client data Premier discharge database Program for evaluating payment pattems electronic report resources (pepper) website Objective Health analysts A MCKINSEY SOLUTION FOR HEALTHCARE PROVIDERS lod-9-cm secondary procedure codes 36.06 (insertion of non-drug-eluding coronary artery stent) and 36.07 (insertion of drug-eluding coronary artery stent.) 2. Total savings per case for hospitals = difference between (total payments received (net revenue minus bad debt) minus total cost per case) for DRG 247+249 (1 day stay only) and OP ICD 9 00.66 principal procedure. Total savings for payors difference betbween total payments made to hospitals. Hospital payments based on analysis of 40 hospitals with average payor mix (Medicare = 55%; Commercial = 35%: Self pay = 5%: Medicaid = 56). Hospital costs based on analysis of 100 hospitals in 300-500 bed range. Copyright 2012, Objective Health, a Mckinsey Solution for Healthcare Providers. THE TRANSITION TO OUTPATIENT OF CORONARY ANGIOPLASTY (PTCA) Coronary angioplasty (PTCA) is a procedure to treat narrow or blocked carotid arteries, usually with the placement of a stent to keep the artery open. The procedure is on the leading edge of a growing trend in US hospitals of transitioning inpatient procedures to the outpatient setting. THE RESULT: LOWER COST OF CARE CORONARY ANGIOPLASTY IS SHIFTING FROM 1 DAY INPATIENT .CREATING ABOUT $2,100 IN BENEFIT, STAYS TO OUTPATIENT PROCEDURES... WHICH IS ALMOST ENTIRELY CAPTURED BY PAYORS $2,100 PERCENT OF TOTAL CORONARY ANGIOPLASTY WITHOUT COMPLICATIONS BY VOLUME 100- 90 - 3+ DAYS INPATIENT TOTAL SAVINGS PER CASE? 80 - >> 70 - 2 DAYS INPATIENT 60 - $100 - $2,000 50 - 1 DAY INPATIENT 40 - HOSPITALS BENEFIT FROM PAYORS BENEFIT FROM LOWER 30 - HIGHER PROFITS PER CASE REIMBURSEMENTS PER CASE 20 - OUTPATIENT 10 - 2008 2009 2010 2011 THERE IS OPPORTUNITY FOR THIS TREND TO CONTINUE AS 20% OF HIGH VOLUME PHYSICIANS HAVE NOT YET TRANSITIONED TO OUTPATIENT PERCENT OF PHYSICIANS WITH >100 CORONARY ANGIOPLASTY CASES PER YEAR; 2011 HIGHEST VOLUME PHYSICIANS 20% OUTPATIENT FOOTNOTE: SOURCES: OBJECTIVEHEALTH" 1. lod-9-cm primary procedure code 00.66 (percutaneous transluminal coronary angioplasty.) Ms-drg code 247 (percutaneous cardiovascular procedures with drug-eluding stent without moc) and 249 (percutaneous cardiovascular procedures with non-drug-eluding stent without mcc.) Objective Health de-identified client data Premier discharge database Program for evaluating payment pattems electronic report resources (pepper) website Objective Health analysts A MCKINSEY SOLUTION FOR HEALTHCARE PROVIDERS lod-9-cm secondary procedure codes 36.06 (insertion of non-drug-eluding coronary artery stent) and 36.07 (insertion of drug-eluding coronary artery stent.) 2. Total savings per case for hospitals = difference between (total payments received (net revenue minus bad debt) minus total cost per case) for DRG 247+249 (1 day stay only) and OP ICD 9 00.66 principal procedure. Total savings for payors difference betbween total payments made to hospitals. Hospital payments based on analysis of 40 hospitals with average payor mix (Medicare = 55%; Commercial = 35%: Self pay = 5%: Medicaid = 56). Hospital costs based on analysis of 100 hospitals in 300-500 bed range. Copyright 2012, Objective Health, a Mckinsey Solution for Healthcare Providers. THE TRANSITION TO OUTPATIENT OF CORONARY ANGIOPLASTY (PTCA) Coronary angioplasty (PTCA) is a procedure to treat narrow or blocked carotid arteries, usually with the placement of a stent to keep the artery open. The procedure is on the leading edge of a growing trend in US hospitals of transitioning inpatient procedures to the outpatient setting. THE RESULT: LOWER COST OF CARE CORONARY ANGIOPLASTY IS SHIFTING FROM 1 DAY INPATIENT .CREATING ABOUT $2,100 IN BENEFIT, STAYS TO OUTPATIENT PROCEDURES... WHICH IS ALMOST ENTIRELY CAPTURED BY PAYORS $2,100 PERCENT OF TOTAL CORONARY ANGIOPLASTY WITHOUT COMPLICATIONS BY VOLUME 100- 90 - 3+ DAYS INPATIENT TOTAL SAVINGS PER CASE? 80 - >> 70 - 2 DAYS INPATIENT 60 - $100 - $2,000 50 - 1 DAY INPATIENT 40 - HOSPITALS BENEFIT FROM PAYORS BENEFIT FROM LOWER 30 - HIGHER PROFITS PER CASE REIMBURSEMENTS PER CASE 20 - OUTPATIENT 10 - 2008 2009 2010 2011 THERE IS OPPORTUNITY FOR THIS TREND TO CONTINUE AS 20% OF HIGH VOLUME PHYSICIANS HAVE NOT YET TRANSITIONED TO OUTPATIENT PERCENT OF PHYSICIANS WITH >100 CORONARY ANGIOPLASTY CASES PER YEAR; 2011 HIGHEST VOLUME PHYSICIANS 20% OUTPATIENT FOOTNOTE: SOURCES: OBJECTIVEHEALTH" 1. lod-9-cm primary procedure code 00.66 (percutaneous transluminal coronary angioplasty.) Ms-drg code 247 (percutaneous cardiovascular procedures with drug-eluding stent without moc) and 249 (percutaneous cardiovascular procedures with non-drug-eluding stent without mcc.) Objective Health de-identified client data Premier discharge database Program for evaluating payment pattems electronic report resources (pepper) website Objective Health analysts A MCKINSEY SOLUTION FOR HEALTHCARE PROVIDERS lod-9-cm secondary procedure codes 36.06 (insertion of non-drug-eluding coronary artery stent) and 36.07 (insertion of drug-eluding coronary artery stent.) 2. Total savings per case for hospitals = difference between (total payments received (net revenue minus bad debt) minus total cost per case) for DRG 247+249 (1 day stay only) and OP ICD 9 00.66 principal procedure. Total savings for payors difference betbween total payments made to hospitals. Hospital payments based on analysis of 40 hospitals with average payor mix (Medicare = 55%; Commercial = 35%: Self pay = 5%: Medicaid = 56). Hospital costs based on analysis of 100 hospitals in 300-500 bed range. Copyright 2012, Objective Health, a Mckinsey Solution for Healthcare Providers. THE TRANSITION TO OUTPATIENT OF CORONARY ANGIOPLASTY (PTCA) Coronary angioplasty (PTCA) is a procedure to treat narrow or blocked carotid arteries, usually with the placement of a stent to keep the artery open. The procedure is on the leading edge of a growing trend in US hospitals of transitioning inpatient procedures to the outpatient setting. THE RESULT: LOWER COST OF CARE CORONARY ANGIOPLASTY IS SHIFTING FROM 1 DAY INPATIENT .CREATING ABOUT $2,100 IN BENEFIT, STAYS TO OUTPATIENT PROCEDURES... WHICH IS ALMOST ENTIRELY CAPTURED BY PAYORS $2,100 PERCENT OF TOTAL CORONARY ANGIOPLASTY WITHOUT COMPLICATIONS BY VOLUME 100- 90 - 3+ DAYS INPATIENT TOTAL SAVINGS PER CASE? 80 - >> 70 - 2 DAYS INPATIENT 60 - $100 - $2,000 50 - 1 DAY INPATIENT 40 - HOSPITALS BENEFIT FROM PAYORS BENEFIT FROM LOWER 30 - HIGHER PROFITS PER CASE REIMBURSEMENTS PER CASE 20 - OUTPATIENT 10 - 2008 2009 2010 2011 THERE IS OPPORTUNITY FOR THIS TREND TO CONTINUE AS 20% OF HIGH VOLUME PHYSICIANS HAVE NOT YET TRANSITIONED TO OUTPATIENT PERCENT OF PHYSICIANS WITH >100 CORONARY ANGIOPLASTY CASES PER YEAR; 2011 HIGHEST VOLUME PHYSICIANS 20% OUTPATIENT FOOTNOTE: SOURCES: OBJECTIVEHEALTH" 1. lod-9-cm primary procedure code 00.66 (percutaneous transluminal coronary angioplasty.) Ms-drg code 247 (percutaneous cardiovascular procedures with drug-eluding stent without moc) and 249 (percutaneous cardiovascular procedures with non-drug-eluding stent without mcc.) Objective Health de-identified client data Premier discharge database Program for evaluating payment pattems electronic report resources (pepper) website Objective Health analysts A MCKINSEY SOLUTION FOR HEALTHCARE PROVIDERS lod-9-cm secondary procedure codes 36.06 (insertion of non-drug-eluding coronary artery stent) and 36.07 (insertion of drug-eluding coronary artery stent.) 2. Total savings per case for hospitals = difference between (total payments received (net revenue minus bad debt) minus total cost per case) for DRG 247+249 (1 day stay only) and OP ICD 9 00.66 principal procedure. Total savings for payors difference betbween total payments made to hospitals. Hospital payments based on analysis of 40 hospitals with average payor mix (Medicare = 55%; Commercial = 35%: Self pay = 5%: Medicaid = 56). Hospital costs based on analysis of 100 hospitals in 300-500 bed range. Copyright 2012, Objective Health, a Mckinsey Solution for Healthcare Providers. THE TRANSITION TO OUTPATIENT OF CORONARY ANGIOPLASTY (PTCA) Coronary angioplasty (PTCA) is a procedure to treat narrow or blocked carotid arteries, usually with the placement of a stent to keep the artery open. The procedure is on the leading edge of a growing trend in US hospitals of transitioning inpatient procedures to the outpatient setting. THE RESULT: LOWER COST OF CARE CORONARY ANGIOPLASTY IS SHIFTING FROM 1 DAY INPATIENT .CREATING ABOUT $2,100 IN BENEFIT, STAYS TO OUTPATIENT PROCEDURES... WHICH IS ALMOST ENTIRELY CAPTURED BY PAYORS $2,100 PERCENT OF TOTAL CORONARY ANGIOPLASTY WITHOUT COMPLICATIONS BY VOLUME 100- 90 - 3+ DAYS INPATIENT TOTAL SAVINGS PER CASE? 80 - >> 70 - 2 DAYS INPATIENT 60 - $100 - $2,000 50 - 1 DAY INPATIENT 40 - HOSPITALS BENEFIT FROM PAYORS BENEFIT FROM LOWER 30 - HIGHER PROFITS PER CASE REIMBURSEMENTS PER CASE 20 - OUTPATIENT 10 - 2008 2009 2010 2011 THERE IS OPPORTUNITY FOR THIS TREND TO CONTINUE AS 20% OF HIGH VOLUME PHYSICIANS HAVE NOT YET TRANSITIONED TO OUTPATIENT PERCENT OF PHYSICIANS WITH >100 CORONARY ANGIOPLASTY CASES PER YEAR; 2011 HIGHEST VOLUME PHYSICIANS 20% OUTPATIENT FOOTNOTE: SOURCES: OBJECTIVEHEALTH" 1. lod-9-cm primary procedure code 00.66 (percutaneous transluminal coronary angioplasty.) Ms-drg code 247 (percutaneous cardiovascular procedures with drug-eluding stent without moc) and 249 (percutaneous cardiovascular procedures with non-drug-eluding stent without mcc.) Objective Health de-identified client data Premier discharge database Program for evaluating payment pattems electronic report resources (pepper) website Objective Health analysts A MCKINSEY SOLUTION FOR HEALTHCARE PROVIDERS lod-9-cm secondary procedure codes 36.06 (insertion of non-drug-eluding coronary artery stent) and 36.07 (insertion of drug-eluding coronary artery stent.) 2. Total savings per case for hospitals = difference between (total payments received (net revenue minus bad debt) minus total cost per case) for DRG 247+249 (1 day stay only) and OP ICD 9 00.66 principal procedure. Total savings for payors difference betbween total payments made to hospitals. Hospital payments based on analysis of 40 hospitals with average payor mix (Medicare = 55%; Commercial = 35%: Self pay = 5%: Medicaid = 56). Hospital costs based on analysis of 100 hospitals in 300-500 bed range. Copyright 2012, Objective Health, a Mckinsey Solution for Healthcare Providers.