Texas hospital cuts costs by cutting back on extras
No-frills’ cardiac care begins with re-evaluation
The Texas Heart Institute in Houston has adopted some impressive cost-saving measures. Each is the result of an exhaustive top-down approach to efficiency. No surgical technique or postsurgery treatment is taken for granted, and each piece of equipment is evaluated to see if it passes muster or could be replaced by a better and cheaper generic substitute.
The following are a few of the measures Denton Cooley, MD, founder of the facility, and the cardiovascular surgery unit have adopted:
• using a Beaver blade to make openings for the aortic anastomoses instead of an aortic punch, which costs more;
• avoiding use of the autotransfusion machine;
• rarely using pulmonary artery catheters or left atrial lines;
• using more reusable towels;
• having staff wear reusable gowns;
• cutting down on the number of gloves that have to be used by buying better quality gloves that last longer.
The cardiovascular surgery unit’s surgical supply pack has 129 items costing less than $400, and its perfusion supply pack costs less than $500. The packs are less expensive than those used by other hospitals because the cardiovascular unit has streamlined them, says Jackie Anderson, RN, MSN, cardiovascular surgery outcomes manager at St. Luke’s.
"They don’t use a lot of extra items, and they use only what they need to use," she says. "It’s more cost-effective if you’re pre-packaging the supply pack from the supplier." St. Luke’s pack has many reusable items, and it doesn’t contain any supplies that might be needed in only a minority of surgeries. Those supplies are still available in the operating room, but they aren’t charged to the patient unless they are needed, Anderson says.
In addition, says Dena Houchin, RN, clinical coordinator in cardiovascular surgery at Texas Heart Institute, the unit uses as little blood as possible.
Cooley has worked more than 20 years on cutting costs. "We’re not compromising the quality of care of patients. We’re just giving them a no-frills operation," explains Cooley, a cardiovascular surgeon.
The Texas Heart Institute is a part of St. Luke’s Episcopal Hospital, a 946-bed facility in Houston. The cardiovascular surgery unit is considered one of the most cost-effective in the country and has performed more than 90,000 open heart procedures since it was founded in 1975.
Cooley began cutting costs long before the managed care movement made it essential. In the late 1980s, Anderson explains, Cooley submitted a proposal to the federal government that essentially asked the government to send its Medicare heart patients to the institute at a set surgical price.
Years later, the federal Health Care and Finance Administration’s demonstration project for bypass surgery was begun, and the institute was one of the first seven hospitals involved, she says. "The thing that is unique here is Dr. Cooley’s vision of how things should be. He’s always been a very forward thinker in looking ahead to the business side of health care," Anderson says.
Program adopted for bypass patients
The cost-effectiveness philosophy has carried over into the cardiovascular unit’s fast-track program for bypass patients. The two-year-old program has reduced the average length of stay by three days, and it has reduced costs by 30%, Anderson says. (See related article on St. Luke’s fast-track CABG program, p. 111.)
Most of the cardiovascular surgery unit’s cost-saving measures have been physician driven, with Cooley leading the charge, says Linda Luy, RN, MBA, manager of the cardiac operating room at St. Luke’s.
"With all the residents and nursing staff working with him, they learned that you can provide quality care with a very simplified setup," Luy states. The unit has eight surgeons, and each surgeon uses the same setup.
Luy says her experience working at other hospitals was quite different. "In other hospitals, it depends on what the surgeon wants, so you may have six surgeons and two or three different packs." The unit also limits the use of disposable supplies and instruments.
"Throughout my professional career, I have attempted to restrict excessive cost in health care, and most of my concepts have been aimed at simplicity and efficiency," Cooley says.
Cost-cutting is reflected in the details, such as the doctor’s rejection of the use of sophisticated types of cannulas in favor of using simple plastic tubes because the cannulas could cost two or three times more. "The cannula might have a slight advantage, but it may be only a slight advantage," Cooley says. "I do not allow the use of various devices that are excessively expensive."
Luy also credits Cooley’s focus on simplicity. "I know there are probably lots of invasive measures that some cardiovascular units take that he doesn’t." The unit’s operation times are generally faster than others. "In some units it’s routine for patients to go into intensive care and be left there two to three days when they only need to stay overnight," Cooley says. "We use step-down units." He says he tries to limit the patient’s time in the operating room and in the intensive care unit because those are the two biggest health care costs.
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