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Knowing the Price

Novel trial at UH shows pathway to reducing health care costs while preserving quality

Harrington Heart & Vascular Institute Innovations - Winter 2018

Vikram Kashyap, MD


Chief, Division of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center, Co-Chair, Clinical Executive Committee, University Hospitals Harrington Heart & Vascular Institute, Alan H. Markowitz, MD, Master Clinician for Cardiac and Vascular Surgery; Professor of Surgery, Case Western Reserve University School of Medicine

In today’s health care environment, physicians are constantly being asked to do more with less, to ensure good outcomes for patients while driving down costs. At University Hospitals Harrington Heart & Vascular Institute, a team has found a simple but novel strategy for doing just that. They’ve shown that simply announcing the cost of supplies requested by the interventional cardiologist during a percutaneous coronary intervention (PCI) leads to a lower per-procedure cost – without affecting patient care.

“There have been some cost-containment studies, but none that specifically announced the cost of equipment,” says Vikram Kashyap, MD, Co-Chair, Clinical Executive Committee of the UH Harrington Heart & Vascular Institute. “So this was novel. Importantly, this intervention did not adversely affect clinical outcomes.”

The UH team published its results recently in the journal Catheterization and Cardiovascular Interventions.

To launch its SHOPPING (Show How Options in Price for Procedures Can Be Influenced Greatly) trial, the UH team gathered baseline data on 10 consecutive PCI procedures performed by nine different interventional cardiologists. Included in the analysis were procedure time and costs for contrast, medications, diagnostic equipment, interventional equipment, imaging equipment and closure devices.

For the intervention, the team labeled the cost of all the endovascular supplies, equipment, devices and disposables in the catheterization laboratory. The staff then announced the price of each item as it was requested during cases, following this procedure for an additional 10 consecutive cases for the nine participating interventional cardiologists. In addition, all interventionalists were told how their per-procedure cost compared to the average cost for the group as calculated during the baseline period.

Results show that increasing cost awareness among the interventional cardiologists did not increase PCI procedure time. It did, however, significantly decrease per-procedure cost.

”We found that total PCI procedural cost was significantly reduced by an average of $234.77, equating to a total savings of $21,129.30 over the course of 90 PCI procedures,” Dr. Kashyap says. “The savings were due to differences in the contrast use and differences in the interventional equipment used. It may be that they used less of some of the expensive modalities that aren’t needed for every case. The total major adverse cardiac and cerebrovascular event (MACCE) rates for both pre- and post-intervention patient cohorts were not significantly different.”

Dr. Kashyap says that although this study has shown the effectiveness of cost awareness as a strategy for reducing the expense of PCI procedures, it could have wide applicability to other fields of medicine.

“Currently, a PCI is a pretty scripted procedure,” he says. “There is very little variation. But I think the bigger message is you could use something like this in an operating room and other environments where there is a lot of variability. That variability could be decreased by people understanding the cost of some of the equipment that is used for those procedures. For example, in the operating room, we use a lot of different hemostatic agents –– there’s literally a table of the different agents that we have. Few surgeons know how much any of these items costs. You could implement something like this in the OR that before any hemostatic agent was opened or any implant was opened, the cost is announced along with other technical details of the product. It’s likely to not adversely affect outcomes because there are other replacement products that are less expensive. Or there could be different techniques or different procedures that one would do that would perhaps avoid using one of those items that have become routine.”

This research also points to the continuing role physicians must play in efforts to drive down health care costs, Dr. Kashyap says.

“In current times, where the increasing cost of health care has become an overwhelming concern and is not sustainable, it is imperative that physicians and health care staff become actively involved in the conscious efforts to reduce the cost of patient care without adversely affecting patient outcomes,” he says.

For more information about this research, please email