Feasability of Office Based Endovascular Practice

Feasibility of Office Based Endovascular Practice
Background
Hospital based outpatient treatment of carefully selected endovascular patients has been established as cost-effective and safe. We report our experience of outpatient endovascular procedures in an office based stand-alone practice.
Methods
Retrospective analysis of all patients treated in our private downtown office was performed. Patients were identified as outpatient surgical patients during routine office visits and scheduled to receive procedures at our office. A RN trained in ACLS and conscious sedation provided anesthesia under direction of the operating surgeon. A Radiology technician operated the C-arm and a scrub technician were available and utilized for all procedures.
Results
Between Feb 2006 and Aug 2008 519 patients received endovascular treatment and/or angiography consisting of venous, dialysis access and arterial procedures. 265 patients (51%) had arterial procedures performed; treatments ranged from diagnostic arteriography to concomitant PTA and stenting. Hemostasis of percutaneous arterial puncture sites was achieved with Heparin reversal, pressure (54.4%)or Angio-seal closure device (45.5%). Two patients required transfer to a local hospital following treatment secondary to bleeding and hypotension from device failure (.64%). One patient was transferred to a hospital because he dislocated his hip getting out of bed and one patient was transferred to the hospital for observation of a hematoma following PTA of a fistula stricture. Patients were discharged home following established discharge criteria after appropriate monitoring in a recovery ward. Patients were kept for an average of 2 hours after a closure device versus four hours after use of pressure alone. Average time in recovery to discharge for all patients was 3 hours 20 minutes. No fatalities occurred during treatment. No morbidity occurred as a result of procedures performed in the office versus the hospital. Facility costs and fees normally collected by the hospital were absorbed by the practice. Maintaining our current practice volume we are able to achieve a 30% overall savings rate to guarantors and payers versus comparable procedures done at the local hospitals. Our costs at this volume rate are calculated to be on average 65% of our collection rate; however, the economic benefit to the practice is still three times greater than comparable hospital based procedures.
Conclusions
Office based practice of treating screened vascular patients requiring outpatient endovascular procedures can be performed safely. Cost savings to the patients and guarantors may be substantial with the added benefit of increased profits to practices.