As new AF ablation technologies, such as Medtronic's Arctic Front cryo balloon, are reaching the market and peaking physician interest, hospital administrators are more closely examining the finances associated with these procedures. With AF ablation predicted to grow in the coming years and more hospitals entering this market, maintaining profitable procedures will become increasingly important.
Roughly 2.2 million patients suffer from atrial fibrillation in the U.S. While there is not conclusive data available on how many of these patients are referred to an EP, it is estimated that at least 10% do not have underlying heart disease despite an episode of AF, making them unlikely candidates for an electrophysiologist consult. Despite the growing number of AF ablations being conducted in the U.S—driven by improved technology and outcomes as well as growing physician experience—these procedures are not appropriate for every patient with AF. Ablations are largely reserved for those with symptomatic AF (roughly 2/3 of patients) who have not been able to tolerate or see improvements from at least one antiarrhythmic drug. These two-thirds may either receive surgical or catheter ablation.
AF ablations can be profitable procedures for many hospitals, though there are a number of limiting factors: most notably, procedure time and payer mix. Procedure times of longer than four hours can tie up lab time excessively, preventing lab clinicians from performing a sufficient number of cases. When physicians first begin performing these procedures, times are often longer as EPs ramp up their technique. Furthermore, adding in the learning curve for remote catheter navigation (Stereotaxis, Hansen systems) or factoring in extended mapping when it might not be necessary also lengthen procedure time.
Payer mix is another component affecting AF ablation profitability. Since private insurers can pay upwards of 2.5 times the Medicare reimbursement rate, having more of these patients can positively affect margins. One progressive AF program interviewed by researchers noted that having more than 50% Medicare patients makes it very difficult for an ablation service to break even. The outpatient shift of many catheter ablation cases affects profitability as well. Some interviewed centers have benefitted from more cases being performed in the outpatient setting as insurers are increasingly working with hospitals to form global payment arrangements for AF ablation cases for outpatients.
Despite the challenges of long procedure times and potentially impairing payer mixes, programs can still achieve profitability as physicians gain more experience, shortening their procedure times, and administrators are able to negotiate favorable reimbursement for many AF patients.