Containing costs while delivering high-quality, effective care is a directive of healthcare reform. Episode-based care is part of the reform mandate and is a payment approach that reimburses on expected costs for clinically defined episodes rather than fee-for-service. Toshiba America Medical Systems, Inc. understands that to address the new episode-based care model, healthcare providers must effectively use patient-focused imaging technology and a multidisciplinary collaborative approach to treatment in order to achieve greater efficiencies and better patient outcomes.
As a world-class neurological and stroke care center, Millard Fillmore Circle Gates Hospital in Buffalo, N.Y., acquired Toshiba's Aquilion® ONE dynamic volume CT system and Toshiba's InfinixTM VF-i bi-plane vascular system to improve stroke diagnosis and treatment. Over the past year, Millard Fillmore has successfully integrated Toshiba's patient-focused technology, multidisciplinary approach, education and training, and community outreach to streamline diagnosis, reduce length of stay and improve outcomes for patients with acute stroke. In addition, streamlining diagnosis has resulted in greater economic efficiencies and reduced overall healthcare costs.
To quantify the results of utilizing the Aquilion ONE in the diagnosis of acute stroke, Millard Fillmore conducted a non-controlled study to measure the impact of 320-detector row dynamic volume CT on the diagnostic workup of patients presenting with stroke symptoms. The study evaluated data from before and after the installation of the Aquilion ONE to evaluate the imaging procedures, inpatient length of stay and discharging disposition for patients with acute stroke. The study compared inpatient data sets from July to September 2007, prior to the Aquilion ONE installation, with data sets from July to September 2009, which utilized the Aquilion ONE, and addressed the top three discharging ICD-9-CM codes. Comparing the patient workups during these two time periods demonstrated the benefits the Aquilion ONE, and its ability to perform whole brain perfusions, brought the facility.
Prior to installing the Aquilion ONE, the majority of patients were imaged using pre-MRI screening and X-ray imaging, limited brain MRI, MR perfusion and MRA of the head and neck. Utilization of the Aquilion ONE showed a significant shift in the diagnostic workup for acute stroke with the use of non-contrast head CT, CT perfusion, CTA head and neck, and MRI brain non-contrast. This expanded use of CT during stroke diagnosis resulted in reduced healthcare costs and improved patient outcomes, as MR is more user intensive and costly. Furthermore, the images produced by CT allowed patients to be moved more quickly into intervention.
"With stroke accounting for 1 in every 18 deaths in the U.S. and costing the healthcare system approximately $50 billion a year, advanced imaging technologies are allowing us to diagnose stroke more accurately and efficiently than ever before," said Elad Levy, MD, FACS, FAHA, professor of Neurosurgery, University at Buffalo Neurosurgery, and director of Endovascular Stroke Service for the Gates Stroke Center. "The whole brain perfusion and digital angiography capabilities of the Aquilion ONE provide our clinicians with the information needed to evaluate the penumbra or the region impacted by the stroke, quickly and accurately."
Highlights of the findings include (full data set on file):
For ICD-9-CM code 434.91 (Unspecified Cerebral Artery Occlusion with Cerebral Infarction) Millard Fillmore saw almost a half-day reduction in hospital stay, had more patients discharged to home and achieved costs savings in the neighborhood of $120,000.
ICD-9-CM codes 435.9 (Unspecified Transient Cerebral Ischemia) and 434.11(Cerebral Embolism with Cerebral Infarction) also saw improvements in these areas. Both had a reduction in hospital stay of 0.14 days and cost savings of more than $30,000 each. Overall, for just these three ICD-9-CM codes, Millard Fillmore achieved an approximate annualized savings of more than $750,000.
"Milliard Fillmore is an impressive example of how an exceptional multidisciplinary team with comprehensive education and community outreach can use innovative imaging technology, such as the Toshiba Aquilion ONE dynamic volume CT and Infinix VF-i bi-plane vascular lab, to improve diagnosis and treatment of acute stroke and reduce overall healthcare costs," said Joseph Cooper, director, CT Business Unit, Toshiba. "Under the upcoming episode-based care payment model it will be more critical than ever for healthcare facilities to achieve clinical utility, operational efficiency and financial performance with their imaging systems."