AFib Ablation in the Surgery Center – the Role of Reprocessing

Last year, I noted that “procedures done in the surgery center are much less expensive and are usually associated with high financial award for the electrophysiologist (who is often a co-owner of the surgery center). Interestingly, one of the drivers behind the growth in surgery center ablation is the fact that the Centers for Medicare & Medicaid Services (CMS) has reduced physician reimbursement significantly in recent years.” The financial incentive for physicians is enormous, and significant amounts of EP ablation procedures are going to migrate out of the hospital setting and into the surgery center. I also noted that this migration will be accompanied by structural changes to the EP ablation procedure:

• New technologies for EP ablation will emerge and develop in the surgery center. Specifically, EP physicians are eager to use Pulsed Field Ablation (PFA) technology in the EP surgery center space, to be able to do certain procedures faster and safer. I have seen EP physicians do up to 8 ablation procedures per day with PFA, while traditional RF ablation procedures take much longer (few physicians can do more than 2 procedures per day).
• PFA-based ablation procedures will also allow for procedures that use fewer devices and have reduced complexity, thereby driving down costs. We will see new technologies that make it easier to either switch between brands or completely eliminate the need for devices – in both cases optimizing clinical choice and efficiency. 
• Some of the best electrophysiologists in the country are going to be among the first to start doing procedures in the surgery center. These physicians will have a different mindset due to who they are, but also due to WHERE they are. They will be performing simpler procedures in less time, utilizing less devices. They will also be making more money.
• Finally, we will see more device re-use: Single-use device reprocessing is already of key importance to the financial sustainability of hospital-based EP ablation procedures – in the surgery center, the physician’s legacy preference for a brand new device will be replaced by the financial appeal of a reprocessed devices that can be acquired at half the price.

Almost all EP physicians are already used to using reprocessed single-use devices in the hospital-based EP lab. Cost savings realized through the use of reprocessed devices have benefited the lab or the hospital (but rarely the physician directly). In the physician-owned EP surgery center, the use of reprocessed single-use devices will assume strategic importance: The cost savings realized from such practices will be critical to the physician’s ability to maximize his/her paycheck.  

In the physician-owned EP surgery center, the use of reprocessed single-use devices will assume strategic importance...

To illustrate, Innovative Health reprocesses single-use cardiology devices so they can be re-used by labs and surgery centers. This serves to reduce procedure costs and enable the use of more expensive devices:

• Using reprocessed single-use will be an easy thing for the physician and the surgery center staff to do – they have been used to this practice in the hospital. While physicians were initially concerned about the safety and functionality of reprocessed devices, such concerns are long gone after 25 years+ of safe use of these devices. In the surgery setting, physicians are likely to be even less concerned, given the direct financial impact of such programs. Labs will be able to set up reprocessing programs easily, supported by the EP reprocessing company.
• EP physician surgery center owners will be able to use reprocessed devices to reduce procedure costs and increase profits. In a classic EP ablation procedure, device costs are about $10-11,000. Using all the reprocessed devices available, procedure costs can be reduced by ~$3,000, which would translate to an increase of the same magnitude in margin and – eventually – physician profit.
• However, there is a more significant role for reprocessing to play: EP physicians can use reprocessing to pay for new technologies. As mentioned, EP physicians are eager to adopt the use of PFA ablation in the surgery center space – because this allows them to do more procedures and increase surgery center (and their own) revenue. The only barrier is that PFA technology is (still) prohibitively expensive. This will change over the next several months, and prices will normalize, but today, while an RF ablation catheter costs around $3,500, a PFA ablation catheter costs about $6,500 (after volume discounts, friends-and-family rebates, etc.). Now the physician is stuck in a dilemma – s/he can do more procedures with PFA, but each procedure will be ~$3,000 more expensive. More revenue, but also higher costs. If the physician can realize $3,000 in savings by using reprocessed catheters, this premium price differential goes away – more revenue, same costs… This is how reprocessing becomes critically important in the surgery center based EP ablation procedure. 

Used single-use devices are collected by the surgery center and sent to the reprocessor. They are then reprocessed by the reprocessor, and the lab or surgery center can purchase reprocessed devices from the reprocessor to supplement new devices and reduce costs. The devices that produce the ~$3,000 in savings include diagnostic EP catheters, introducer sheaths, transseptal needles, ICE catheters, and mapping catheters. 

In order for the lab/surgery center to be able to buy back reprocessed devices, devices must be handled according to the reprocessor’s collection instructions. This ensures the devices can actually be reprocessed and re-used. A lab or surgery center must collect devices to participate in a reprocessing program. Due to device rejections and limits to how many times a device can be reprocessed, the lab/surgery center can typically purchase the equivalent of 80% of what is collected.