Background: Although point-of-care ultrasound can improve patient care and reduce unnecessary downstream costs, few economic models exist on hospitalist use and whether remuneration for imaging could offset equipment costs. As the heart and lungs are commonly examined during admission, we observed the frequency of use and projected fiscal outcomes of point-of-care cardiac ultrasound by an admitting physician carrying a pocket-sized device (PSD).
Methods: We analyzed the unbiased use of a PSD (VScan, GE Healthcare) provided to consecutive senior residents during a night hospitalist rotation in a 300-bed community hospital. All residents had previously completed 1-year of required training in cardiac limited ultrasound examination (CLUE) to augment their bedside diagnostic skills for LV dysfunction, left atrial enlargement, pulmonary edema and effusions, and elevated central venous pressures and were subsequently free to use the PSD at their own discretion during the hospitalist rotation. During a convenience sampling of admitting nights over a year, residents relayed details of consecutive emergency department admissions and their reasons for performing CLUE. Using 3 certified medical billing services as resources, an economic model was created to project billing charges for residents with both high (>50% of admits) and low frequency (<20% of admits) CLUE use, based upon ICD-10 codes for medical necessity and the Medicare allowable for limited echo (CPT 93308-26) and thorax imaging (CPT 76604-26). Total CLUE collections were projected for our hospital’s payor mix by applying the % return on charges for inpatient standard echo interpretations (CPT 93306-26). Pay-off time(T) was defined for the total cost of 1 PSD ($8000) and overhead (15% of returns), for group and individual use.
Results: Over the 77 shifts, 19 residents performed 138 CLUEs on 378 admissions (4.9/shift) for a mean(±SD) usage of 37.2±19.9% (range: 13.3-89%). Projecting a volume of 14.7 admits/d and use of 1 shared device, modeling predicted $5132/mo could be collected, or $31/use, and T=1.6 mo. Low and high frequency use earned $2385/mo and $7879/mo with T=3.4 and T=1.0 mo, respectively (Graph). With our hospital’s payors % return of 85% for echo, T=1.7 mo. Sensitivity analysis that varied only % return (50%-95%) and physician usage (20%-60%) resulted in a T range of 1.0-6.3 mo. For an individual hospitalist working 15 shifts/mo, mean T =10mo (range 6.1-38mo).
Conclusions: Remuneration for a cardiopulmonary limited ultrasound exam using a pocket-sized device on hospital admissions could pay off equipment costs at 1.6 months for group use and 10 months for individual use. Future studies could include PSD use in other organ systems and address the wide variation of physician usage.