New Devices, How do you Evaluate the financial impact?

When a department or service line wants to deploy a new device how does your team evaluate the financial impact? Do you have a standard checklist or process you use to determine if your reimbursement will at minimum cover your cost? I am sure we have all experienced that last minute call saying, we have this case scheduled in 2 weeks....


  • First question- who allowed that device to be ordered for use at the hospital without an analysis being done? 
    You need to look at thes following factors:
    ØFDA/CMS/Insurance approvals
    ØMedical Necessity, Appropriate Use Guidelines
    ØEquipment costs- fixed and per procedure
    ØStaff training
    ØReimbursement- DRG / APC / fee schedule
    ØPrecertification requirements
    ØExpertise of physicians

    The last is most important to me. Does patient number one know the doctor has never done the surgery on a human being ever? What's the learning curve? 
  • Good point Dr. Hirsch on if patient 1 knows they are the very first. I am checking with our clinical teams that are getting ready to deploy Mitraclip.

    Our organization has taken another approach to try and get ahead of these items via a Shared Services Workgroup. If an item was not a part of our annual strategic planning then it must come through our group for investigation and approval. Our group consists of Rev Cycle, HIM,  Finance, Materials/Purchasing, Facilities, IT, Compliance, Contracting, and Security. This allows the entire group to be presented the idea via a questionnaire that is required. This questionnaire also requires that the presenter has discussed and gotten the approval from their CEO to move forward. The group can ask questions and further research the project from their department needs and then at a future meeting we lay out all we have found. If it is not clear if we should move forward we push it to a higher level group with all of the details. This has really opened the eyes of leaders in the organization on how just a "little valve device" can actually be quite expensive for the facility and needs to be monitored closely to ensure we are following guidelines and documentation for the procedure to obtain maximum reimbursement. We know that these items will continue to pop up, we just hope that we are able to funnel them through our group and more effectively evaluate and manage future  devices/procedures/service lines.

  • What a great system. Can I ask- you mention the CEO approval is needed before the group review. Is that just a doctor wandering into the CEO office and saying they want to start using Mitraclip and that the hospital will make a lot of money and the CEO says "sure" or is it a formal process?
  • They must indicate on the questionnaire as well as we have a tracking system AcheiveIt,  where we tag the CEO for that area so they have visibility. We, Rev Cycle and Finance circle back with the CEO over the facility that the program will impact financially.

    You described the exact scenario that we encounter with all new devices, low cost to us and huge revenue opportunities is how they are all described!

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