If PVD services are provided in existing surgery and interventional radiology suites, no additional capital costs can be expected. The expansion of catheter-based care in cath lab to include peripheral vascular interventions will give rise to additional expenses. Imaging requirements for PVD patient may require new equipment purchases but many hospitals have been able to adapt existing coronary cameras. Specialized supplies are also required. Staff education and training must be expanded to include peripheral procedure techniques and potential complications.

Revenue from PVD care provides opportunity for healthy margins for hospitals. Medicare contribution margins for vascular DRGs compare favorably with cardiac DRG margins. Across all vascular DRGs average contribution margin (revenue less direct costs) is more than 30 percent (Source: Market Insights, Inc., San Francisco; Cardiovascular Roundtable analysis 1999).

While there are no statistics on revenue generating figures for interventional radiologists and cardiologists treating PVD, a recent survey provides that information on vascular surgeons. Results from a survey of 1,200 hospital CFOs reveals that vascular surgeons generate an average of $2.2 million in revenue—derived from referrals and associated treatments—for their affiliated hospitals each year.

Where to Go to from Here?

Cardiovascular care is big business. This year alone, American Heart Association anticipates that $329 billion will be spent on this patient population. While PVD portion of total is significantly smaller than cardiac portion, patients are same. Peripheral vascular care is an essential component of full service cardiovascular care.

There is no question that number of PVD patients is growing and these patients are underserved today. Hospitals must decide how to best care for this population. One of first steps is compiling a PVD dedicated business plan that covers: •Market size/opportunity •Competitive environment/issues •Scope of service •Physician specialties/medical coverage •Clinical operations model •Marketing and outreach initiatives •Financial requirements/assumptions •Structure/governance/ownership •Conditions for success •Implementation recommendations and timeline

With growing trend toward healthcare self-education supported through press and Internet, public is becoming increasingly aware of potential dangers of untreated vascular disease. Quality of life has taken on new meaning and older population will continue to seek healthcare resources that will enable them to maintain active lifestyles. Be prepared for baby boomers to seek out and demand assessment and treatment of peripheral vascular problems.

Barbara Sallo, RN, MBA is President of Health Care Visions, Ltd. a cardiovascular consulting firm based in Pittsburgh, Pennsylvania. The firm brings extensive knowledge and expertise in this area of clinical care. Health Care Visions, Ltd. has assisted a multitude of hospitals in all phases of cardiovascular programs from market assessments, program assessments and feasibility studies to business planning and implementation.

Operational and staffing cost efficiencies Patients in One Stop Post Op™ are cared for by nurses with advanced critical assessment skills and cardiovascular recovery care experience who are prepared to identify post-op complications and address care needs earlier. Problems are identified and resolved quickly with all members of team understanding their role. The One Stop Post Op™ facilitates continuous quality enhancement in one setting. Staffing is flexed to optimize resources and can be adjusted every four hours.

Continuous communication Due to specialized nature of post operative open heart surgery care and need for a dedicated care team, care givers share a common goal and have constant opportunity to dialogue. The patient is not moved and same nurses, physicians, and support staff care for them during their entire stay. Active family communication and involvement is a corner stone of this delivery system, making patient and their family focus of all activity. The patient and family receive education from same staff that is administering post operative care. They are encouraged to question therapies and treatments and are involved in care decisions through out patient hospital stay.

Active family involvement The One Stop Post Op™ unit fosters an environment centered on patient and family. Family visiting is open and supported with rooms optimally designed to address this unit’s approach. The family is included in pre-operative teaching and continues to be an active participant in educational process through patient discharge. Interactions with familiar nursing staff promote active communication. The families have also found that surgeons are frequently in unit and available to discuss patient’s recovery process and answer their questions.

Employee ownership Another unique feature of The One Stop Post Op™ model is that it creates an empowering environment, which fosters ownership. The nursing and ancillary staff assigned to these units tend to refer to OHS patients as “our patients”. The opportunities for bonding between staff, patients and families are extraordinary. Medical direction provides for a defined understanding of duties and responsibilities so that unit performance expectations are clear and achievable for caregivers.

Clinical expertise The nursing care provided in The One Stop Post Op™ cardiovascular unit is highly specialized. Nurses who traditionally worked in short term recovery units are caring for patients through out their hospital stay and are encouraged to approach patients from a holistic platform. Caregivers interact with patients and families through continuum of care and are able to appreciate success of patient discharge. Nurses with critical care skills provide care at all levels. This expertise provides opportunity for extraordinary trust between physicians, patients, families and ancillary staff. Complications are recognized quickly by nursing staff and timely response can prevent compromise to patient’s condition.

Distinguish your program from competition The traditional care delivery method of transferring patients based on acuity is utilized by most facilities nationwide. By implementing One Stop Post Op™ approach to open heart surgery recovery, hospitals can offer differentiated and distinguish care. Reduced length of stay and exemplary clinical outcomes are benchmarks of a successful program that will be attractive to community and payors of healthcare. The satisfaction achieved by patients and stakeholders will clearly set this type of open-heart surgery program apart from others.