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The Clinical And Financial Impact Of Establishing An Office-based Vein Center Within An Academic Medical System
Yancheng Dai, MD1, Dejah R. Judelson, MD
1, Douglas W. Jones, MD
1, Andres Schanzer, MD
1, Dawn Durocher, BA
2, Francesco A. Aiello, MD, MBA
1.
1Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA, USA,
2UMass Memorial Medical Center, Worcester, MA, USA.
OBJECTIVES:Advances in minimally invasive venous treatments and decreasing professional reimbursement have shifted superficial venous evaluation and treatments from outpatient hospital settings to office-based practices. We sought to evaluate how establishing an office-based vein center, within an academic medical system, impacted clinical volume, procedural efficiency, and reimbursement for the vascular surgery division.
METHODS:A retrospective cohort study was conducted comparing venous services performed by vascular surgeons at an outpatient hospital(OH) facility and a freestanding office-based vein center(VC). In 2018, venous patients were transitioned from the OH to the VC. OH data from 10/1/2016 to 9/30/2017 were compared to VC data from 10/1/2022 to 9/30/2023. Data collected were clinical volume (office visits, vascular lab studies, procedures), procedural efficiency defined as check-in and check-out times for venous procedures, and net reimbursement defined as actual revenue collection minus direct (clinical supplies, staff, provider) and indirect (overhead, depreciation, rent) costs.
RESULTS:In 2017, 317 venous procedures were performed in the OH: 164 endovenous treatments, 33 stab phlebectomies, and 120 sclerotherapies. In 2023, 713 venous procedures were performed in the VC: 510 endovenous treatments, 72 stab phlebectomies, 118 sclerotherapies, and 13 other venous procedures. Between 2017 and 2023, overall procedural volume increased by 125%. During the same period, clinic visits for venous disorders in the OH decreased from 1,374 to 772, and venous vascular lab studies decreased from 686 to 321. However, this decrease was more than compensated for in the VC where 3,122 clinic visits and 1,735 vascular lab studies were performed in 2023. The average time spent in-facility for endovenous therapy decreased by 73% (244 minutes in the OH to 65 minutes in the VC), while in-facility time for stab phlebectomies decreased by 79% (420 minutes in the OH to 87 minutes in the VC). In 2023, the total clinical revenue at the VC was $1,931,516, with total costs of $1,565,561 ($1,262,804 direct costs, $302,758 indirect costs), resulting in a net reimbursement of $365,955 for the vascular surgery division.
CONCLUSIONS:The creation of a dedicated, freestanding office-based vein center within an academic medical system leads to increased procedural volume and efficiency, and provides opportunities for enhanced clinician reimbursement. Vascular surgeons should seek out opportunities to be clinical leaders and financial stakeholders in sites of service outside of traditional hospital settings.
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