Author + information
- Zaher Fanari1,
- Tim Zinselmeier2,
- Jennifer Nichelson2,
- Kurtis Heil2,
- John B. Gill3,
- Shailesh Nandish2 and
- Jeffrey A. Goldstein2
Although transcatheter aortic valve replacement (TAVR) provides an important alternative for patients with severe aortic stenosis, it is associated with high cost and potential economical burden for the hospital performing it. Applying lean processes may help in identifying and reducing potential wastes and costs.
Utilizing Lean Six Sigma Process, we were able to identify 6 potential resources of waste and set goals to reduce cost. Targets for improvement included: The DRG coding initiative (to improve billing coding and comorbidity documentation), Reducing PACT Penality, Pacemaker utilization, ICU Utilization and ancillary staff utilization. Revenue from this initiative was followed over time.
Data were compared for 6 months before and 9 months after TAVR. There were 89 patients included in the analysis before the intervention and 144 after. The DRG coding initiative resulted in an average gain in reimbursement of $465600 over 9-months period. The PACT Penality initiative resulted in significant reduction of cases penalized from an average of 18% to 10% (P=0.003) saving $36577. Pacemaker Utilization initiative resulted in a reduction of pacemaker utilization from 18% to 10% P=0.003) saving $55200. The ICU utilization decreased from 100% to an average of 33% (P=0.005) saving $34510 over 9 months. Similarly the perfusion/surgical staff utilization decreased from 100% to an average of 28% (P=0.003) saving $46669 over 9 months. Overall over time the project resulted in an average significant cost saving of $4414 per TAVR.
Applying lean processes may provide a reasonable approach to identify potential sources of cost waste and reimbursement loss in TAVR procedure and design a sustainable algorithm to reduce loss and improve potential revenue of TAVR program.