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Although transcatheter aortic valve replacement TAVR provides an important alternative for patients with severe aortic stenosis, it is associated with high cost with potential economical burden on hospital performing it. Applying lean processes may help in identifying and reducing potential wastes and costs. Applying lean processes may help in identifying and reducing potential wastes and costs.
Utilizing Lean Six Sigma Process we were able to identify six potential resources of waste and set goals to reduce cost. Targets for improvement included: The DRG coding initiative (to improve billing coding and comorbidity documentation), Reducing PACT Penality, Pacemaker utilization, ICU Utilization and ancillary staff utilization. Revenue from this initiative was followed over time.
The DRG coding initiative resulted in average gain in reimbursement of $340,800 over 6 months period. The PACT Penality initiative resulted in significant reduction of cases penalized from average of 18% to 10%. Pacemaker Utilization initiative showed that despite the high percentage of 18% of patients requiring pacemaker, most of these patients (90% at 30 days) were pacer dependent. The ICU utilization decreased from 100% to an average of 33% (P=0.005) resulting in a saving $28,826 over 6 months. Similarly the perfusion/surgical staff utilization decreased from 100% to an average of 19% (P=0.002) resulting in saving $35,518 over 6 months. Overall over time the project resulted in an average significant cost saving of $4218 per TAVR.
Applying lean processes may provide a reasonable approach to identify potential sources of cost waste and reimbursement loss in TAVR procedure and designed a sustainable algorithm to reduce loss and improve potential revenue of TAVR program
STRUCTURAL: Valvular Disease: Aortic