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Scooped by Seth Bilazarian, MD
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#OnThisDay 25 years ago Trial of Outpatient vs. Inpatient Cardiac Catheterization

#OnThisDay 25 years ago Trial of Outpatient vs. Inpatient Cardiac Catheterization | Heart and Vascular Health | Scoop.it

To evaluate the safety and cost of outpatient cardiac catheterization, we conducted a randomized trial at three hospitals of outpatient (n = 192) as compared with inpatient (n = 189) cardiac catheterization in low-risk patients.

There were no significant differences between the two groups in whether they resumed normal activities or in the rates of rehospitalization within one week of the procedure. Total catheterization-related charges per patient were $679 lower for outpatients, with total savings in hospital charges of $885 per patient.

We conclude that elective cardiac catheterization as an outpatient procedure for selected patients is feasible and safe. Given the small size of our sample, however, we urge caution in interpreting these findings, since they do not exclude a small increase in complication rates with outpatient cardiac catheterization.

Seth Bilazarian, MD's insight:

25 years ago this paper helped pave the way for outpatient catheterization.  Coronary angiography (pictures of the heart arteries) was done at the time only as an inpatient with an overnight stay.  In the last few years, hospitals have just begun taking the next step, allowing outpatient same day discharge after coronary angioplasty (PCI) and stenting.  These changes are welcomed by patients (more comfort at home), hospitals and insurance payers (lower cost), but have been adopted slowly by physicians.

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Scooped by Seth Bilazarian, MD
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Hospitals to Congress: Drop Payment Cap Proposal

Hospitals to Congress: Drop Payment Cap Proposal | Heart and Vascular Health | Scoop.it

My comment: Unfortunately this is the way things are going from the Medicare adminstrator CMS.  Fees for important services like Echocardiograms and Nuclear stress tests have been dramatically cut when done in physician offices to rates that cannot be sustained.  Many physicians have merged with hospitals because the EXACT same service billed by the hospital is reimbursed 4 times higher.  (Echocardiogram $1,605 vs. $373)

See Same Doctor Visit, Double the Cost

http://professional.wsj.com/article/SB10000872396390443713704577601113671007448.html?mg=reno64-wsj

So now CMS intends to cut the reimbursement to the outpatient physician level.  Common sense & fairness would lead to a fair payment regardless of where the service is provided but these are the capricious aspects of our reimbursement system.  Physician groups should not be paid so little and hospitals should not be paid so much.

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The nation’s four largest hospital associations and their allies are urging Congress to oppose a cap on payments for outpatient services.

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