Thursday, January 17, 2008

How to Save Costs in Electrophysiology

Just give patients a three-year wait and reimburse hospitals $1600 for an atrial fibrillation ablation:
David Babiuk, interim provincial executive director for Cardiac Services BC, says the Ministry of Health and the Provincial Health Services Authority (PHSA), acknowledge that current wait times for electrophysiology procedures such as cardiac ablation are unacceptable, and that work is being done to address the issue.

“The wait list is unacceptably high and everybody has acknowledged the fact that this has grown to a state that is not acceptable and no one has attempted to explain or justify that wait,” Babiuk told the Observer. “By the end of January, early February, we’re looking to have completed a review of the current wait list and the indications per use, and… what are all the things that we could do to whittle that wait list down. We won’t be able to do it in 15 months, but we’ll make sure we can get as many people off that wait list as quickly as we can.”
So not only do you have to make 'em wait and pay poorly, you also have to just "whittle that wait list down."

It's no surprise, really. What's amazing is they're still being done at all.



Dreaming again said...

Please explain the why it's amazing they are still being done at all.

My hubby has atrial fib ..controlled most of the time with meds. Although, when it acted up really badly, I did hear this term used (ablation) but a change and increase in medication was all he needed.

Is it not effective? Or is there something more effective? Just curious as to why you're saying it's amazing they're still being done.

Curiosity is gonna get me one day

View from the Trekant said...

I'll bet Dr. Wes is referring to the rationing of health care more than to the effectiveness of ablation.

If single payer care is so fabulous, why are there Canadians in my waiting room willing to pay cash on the barrel head rather than wait and receive the care their taxes already supposedly funded there?

They can't even stay at home to buy private care. It's illegal -considered cutting in line -so they come across the border. I don't get how a system that doesn't allow you to spend your own resources for your own body or for the health of a loved one can be compatible with any reasonable understanding of human rights.

Ablations are expensive enough that few would have the resources to pay outside their system. (Although from what I've seen my EP partners are grossly underpaid for what they do. Spending 4-6 hours in the lab sometimes trying to accomplish a difficult ablation for a fee that realistically doesn't cover the first hour of their time is not uncommon. It's all for the love of seeing the delta wave melt away or finding that secret pathway.

Or am I off the mark, Dr. Wes?
- Echodoc

DrWes said...

Sorry about the delay, but I just finished my first ablation of the day... (need I say more?)

Echodoc -
You're right on.

dreaming again -
Afib ablation can be effective, but as Echodoc points out, they require a significant time commitment, expensive equipment to perform safely, and highly skilled lab staff. $1600 dollars would not conver the consumables in our lab, let alone salaries.

In the right center, there's nothing wrong with afib ablation in the appropriately-selected patient.

Although I do not live in Canada, the rationing there seems not only dependent on availability of facilities, but also an "oversight" body that determines who wins the lottery for ablation. In the end, patients are left with less than ideal options. But we also have to be realistic about costs since dollars don't just grow on trees (except in the US, where the government just prints more). If patients handled their OWN money (with a backup system for catastrophic illness), seems they could make the best decisions for their own priorities/circumstance.

If life were just so easy...