Peripheral Vascular Care: Should You Have a "Vascular Center"?

Written by Barbara Sallo, RN, MBA


Cardiovascular care is big business for hospitals. While a lot of attention and resources are directed to care and treatment ofrepparttar coronary arteries, peripheral vascular (PV) care has gained momentum. Even thoughrepparttar 115151 dollars spent on PV care are significantly less than for cardiac,repparttar 115152 patients arerepparttar 115153 same and PV care is an essential component of full service cardiovascular care. Hospitals are researchingrepparttar 115154 needs of their communities and determining whether they should have a PV care focus and what should that look like. Due diligence and business model planning will lead torepparttar 115155 most appropriate answers. The outlook for potential patients is promising. Today attention is becoming increasingly focused on vascular care, in light of dwindling open heart surgery volumes, reimbursements and increasing costs of supplies for cardiac catheterizations and interventions. Hospitals aroundrepparttar 115156 country are getting serious about capturing market share and centralizing services for peripheral vascular disease (PVD) care. Inrepparttar 115157 past, fleeting attention has been given to PV disease with some facilities providing PV services, but seldom was an entire program focused specifically on PVD. A number of factors have influencedrepparttar 115158 development—or lack of development—of these programs, withrepparttar 115159 greatest being PVD’s “big sister,” coronary artery disease, claiming most ofrepparttar 115160 healthcare attention, to say nothing about its appetite for resources. Should your hospital or health system focus on and commit resources to enhance PVD services? What isrepparttar 115161 market opportunity? What isrepparttar 115162 revenue potential? What does a “best” program look like? Spending time completing research and working through these questions will takerepparttar 115163 guesswork out of identifyingrepparttar 115164 emerging opportunity for peripheral vascular disease care for your organization. What is PVD? PVD is a condition in whichrepparttar 115165 arteries that carry blood throughoutrepparttar 115166 body become narrowed or clogged. This interferes withrepparttar 115167 normal flow of blood and can cause pain, physical limitations and reduced quality of life. The most significant risk factors for PVD is age. The older population is projected to double overrepparttar 115168 next 30 years, reaching 70 million by 2030, escalatingrepparttar 115169 demand for PVD care. A national study: PAD Awareness, Risk and Treatment—New Resources for Survival (PARTNERS published inrepparttar 115170 Journal ofrepparttar 115171 American Medical Association, JAMA September 19, 2001) found that PVD is seriously under-diagnosed and under-treated. The American Heart Association and Harvard Health estimate:

300,000 PVD cases are diagnosed each year. Eight to 10 million Americans are affected. PVD is two to five times more common in men. PVD patients have a six-fold higher death rate from cardiovascular disease. PVD patients have a 15 percent chance of dying within five years when symptomatic. PVD patients have a 50 percent chance of dying within 10 years from PVD. What isrepparttar 115172 PVD Market Opportunity? The patients at risk for coronary artery disease arerepparttar 115173 same patients that will be at risk for PVD. The arguments for concentrating efforts on care specific to this patient population makes good business sense—the patient populations are synergistic and currently interventional radiologist, vascular surgeons, primarily care physicians and most recently cardiologists can diagnose and treatrepparttar 115174 conditions. The increase of patients presenting with symptoms and needing access to care for PVD conditions is anticipated to grow significantly overrepparttar 115175 next twenty years as shown in Exhibit 1. Often times, hospital business development and planning departments are charged with definingrepparttar 115176 market for services and estimatingrepparttar 115177 demand and revenue opportunity. The feasibility models start with identifyingrepparttar 115178 population at risk and applying utilization rates to determine procedure and admission volumes. PVD care has been tracked and measured but estimates are considered to be low because it is believed that older adults have, inrepparttar 115179 past, lived with their “disability”, accepted limitations and pain with ambulation, and attributed nocturnal leg pain and cramps to “old age”. The demanding “baby boomers” are expected to be less accepting of these disabilities as they become octogenarians. A reasonable approach to estimating demand: Review national prevalence and utilization rates that are available fromrepparttar 115180 Vascular Disease Foundation or The Agency for Healthcare Research and Quality Review state utilization rates, if available, as they will provide a more realistic representation of specific geographic areas Apply these rates torepparttar 115181 population served byrepparttar 115182 facility, by age group, to obtainrepparttar 115183 available market estimates as shown in Exhibit 2 Who Treats PVD? Treatment for PVD can follow three main pathways: Noninvasive disease management that includes risk-factor reduction, medications to relieve symptoms while increasing exercise tolerance, including gene-based therapy. Surgical intervention that is safe and effective for many patients in whom less invasive procedures are not adequate. Catheter-based treatments that have an important and increasing role inrepparttar 115184 treatment of PVD and are being substituted for surgery. Primary Care Physicians are oftenrepparttar 115185 first provider to identifyrepparttar 115186 problem. Cardiologists may identify PVD during cardiac catheterization procedures. The more complicated issue related to PVD is which specialist should provide treatment oncerepparttar 115187 disease has been diagnosed. Traditionally, interventional radiologists and vascular surgeons have treated patients with advanced stage PVD. Withrepparttar 115188 advancement of catheter-based interventions, cardiologists are increasingly diagnosing and treating PVD inrepparttar 115189 catheterization lab setting. This shift has setrepparttar 115190 stage for cultural and political “turf wars” that need to be addressed and resolved if a hospital is to have a full service, integrated program. What arerepparttar 115191 Components and Design of a Vascular Center? The “Vascular Center” can have a distinct physical plant location or can be developed as a “virtual” care model. It is certainly recommended that some or most ofrepparttar 115192 “front door” areas are designed to be patient friendly and centralized with good signage and convenient parking. The majority ofrepparttar 115193 PVD care is outpatient andrepparttar 115194 population is challenged to walk long distances. The designated Vascular Center can berepparttar 115195 main geographic location for admissions and screening functions providingrepparttar 115196 referral and coordination for additional diagnostic studies and treatment. Additionally, prevention, education and outreach staff can be housed in this area and can support a “cross functioning” staff model. A sample design for a Vascular Center is shown in Exhibit 3.

Mr David J. Adams

Written by Michele Carelse


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