PURPOSE: Pulmonary practices have been slow to adopt IP programs for several reasons, including the perceived cost. We postulated that cost is a surmountable barrier using a dedicated program with a center of excellence (COE) approach within a large center or practice. We further postulated that a dedicated interventional pulmonologist (IP) would grow the practice overall, procedure related and not.
METHODS: For 2006 and 2007, we tracked procedure volume, reimbursement per procedure, case complexity, costs and impact on the larger practice of adding a new full service IP program in 2007 to a well established suburban community based practice. We compared to the immediate prior year before the addition of the IP Program. One IP and support staff but no other physicians were added during 2007. The practice agreed at the outset to have the ip dedicated fully to procedure related pulmonology and that basic procedures such as simple bronchoscopy could be performed by all practitioners. Advanced procedures were performed by the IP. Costs were assigned in a manner that distributed all attributable costs across the practice consistently.
RESULTS: The IP began in mid-February 2007; although, data was compared to the full year of 2006. Procedure volume increased 12.5% (14.3% extrapolated for the full year). For the practice, average reimbursement per procedure increased 41.1%. When newer IP procedures were compared, reimbursement per procedure increased 107.2%. We view reimbursement per procedure as a surrogate for increased procedure complexity. As evidence of downstream impact, lung cancer diagnoses in one hospital increased 8.6% in the first 10 months. 10 month profit margin was 13.5%. All other indicators of activity across the practice showed gains. Growth continues.
CONCLUSION: Our experience shows that a dedicated IP program is financially viable and enhances all aspects of a practice without cannibalizing existing activity. It is best done as an efficient COE designed for a wide region.
CLINICAL IMPLICATIONS: Improved patient offerings can be finacially supported. We hope to extend this analysis to markers of improvements in quality.
DISCLOSURE: Kevin Kovitz, No Financial Disclosure Information; No Product/Research Disclosure Information