Today's cardiovascular outpatient market is increasingly shaped by payers steering patients to lower-cost sites and growing patient demand for lower-priced, convenient services. At the same time, new site-neutral payment policies are reducing Medicare reimbursement for certain hospital-owned facilities.

To respond to these trends, many cardiovascular leaders are evaluating the potential impact of shifting services off campus, and some are even beginning to think about offering more competitive prices in their outpatient facilities.

This tool allows organizations to assess the potential impact of three types of price changes on total cardiovascular revenue:

• What happens if you change the list price for one or more services?
• How would a change in Medicare fee schedules for a given facility (e.g., from hospital to provider rate, or from hospital outpatient to the site-neutral rate) impact your revenue?
• How would a change in negotiated rates between your organization and a payer affect your net revenue?

Using data you provide, the tool will produce the following outputs:

• Projected total annual revenue for each sub-service line at your current list price, taking into account your contract mix and the percentage of list price you are currently paid
• The net revenue impact of price, site of care, or site-neutral status changes
• The absolute and percentage volume growth required to break even if you change your list price or are subject to a site-neutral rate

Download the Calculator

How to use this tool

To use the Cardiovascular Price Shift Calculator you will need to provide the following inputs:

• Payer mix (proportion of patients falling under each type of payer contract including self-pay)
• For each contract type, a percentage reflecting how rates under that contract relate to Medicare rates. Alternatively, to analyze a single procedure, input the specific procedure rate
• Select provider (MPFS technical or global), hospital outpatient (HOPPS), or site-neutral rates as a baseline Medicare assumption
• A list of CPT codes and one-year volumes for each CPT code

Please enter these inputs into the corresponding pink cells on the spreadsheet. All pink cell are editable.

Analytic assumptions

Medicare reimbursement rates are calculated and geographically adjusted for all CPT codes. The tool is updated every year to reflect new Medicare rates. See our Methodological Note for additional details.

Contact us

For questions about this tool, please feel free to email us at cardiovascular@advisory.com.