The Cost Savings Of An Office Based Laboratory
Shon Shmushkevich, BS, Neil Poulsen, MD, Clifford M. Sales, MD.
The Cardiovascular Care Group, Westfield, NJ, USA.
OBJECTIVES:: The management of vascular disease, as with most clinical care, continues to evolve as society adapts to a post Covid-19 era and related costs and shortages. Superb clinical outcomes are no longer the singular metric used to judge success—rather they have become expected. Attention to access, indications and cost-reduction are now central to patient care. Office-based laboratories (OBLs) provide an alternative to hospital-based care that is efficacious, accessible and cost-containing. While the current literature has raised questions about the utility and quality of care in OBLs, we sought to evaluate our OBL experience, considering the financial implications it has on the overall medical system. Methods: A pro-forma financial analysis utilizing current Medicare fee schedules for our locale was conducted. The study incorporated an internal report of procedures performed in a single OBL during a 12-month period. A listing of the primary code for each procedure was compiled from our EMR system. The frequency was noted and multiplied by the fees that would be paid by the local Medicare carrier if the procedure were performed in the hospital (HCPCS plus Physician Fee) or in the OBL (Site-11 global fee). The totals for each site-of-service were calculated and compared. Results: The analysis identified 1,741 procedures performed in a single OBL over 12 months. Using this distribution, we calculated a total payment (using only Medicare fees) of $2,453,652 for the site-11 (OBL.) The cost to the local Medicare carrier would have been $2,916,095 ($2,539,896 for hospital facility fees and $376,199 for Physician Fees.) Therefore, utilizing an OBL allowed the Medicare program to realize a savings of $462,443 or 18.8%. Conclusion: While costs for healthcare continue to increase, it is vital to consider the financial implications of any intervention. Our analysis posits a significant cost reduction for vascular procedures when performed in OBLs as compared to the in-hospital settings
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