Peripheral Vascular Care: Should You Have a "Vascular Center"? by Barbara Sallo, RN, MBA

Cardiovascular care is big business for hospitals. While a lot of attention and resources are directed to care and treatment of the coronary arteries, peripheral vascular (PV) care has gained momentum. Even though the dollars spent on PV care are significantly less than for cardiac, the patients are the same and PV care is an essential component of full service cardiovascular care.

Hospitals are researching the needs of their communities and determining whether they should have a PV care focus and what should that look like. Due diligence and business model planning will lead to the most appropriate answers. The outlook for potential patients is promising.

Today attention is becoming increasingly focused on vascular care, in light of dwindling open heart surgery volumes, reimbursements and increasing costs of supplies for cardiac catheterizations and interventions. Hospitals around the country are getting serious about capturing market share and centralizing services for peripheral vascular disease (PVD) care.

In the past, fleeting attention has been given to PV disease with some facilities providing PV services, but seldom was an entire program focused specifically on PVD. A number of factors have influenced the development—or lack of development—of these programs, with the greatest being PVD’s “big sister,” coronary artery disease, claiming most of the healthcare attention, to say nothing about its appetite for resources.

Should your hospital or health system focus on and commit resources to enhance PVD services? What is the market opportunity? What is the revenue potential? What does a “best” program look like? Spending time completing research and working through these questions will take the guesswork out of identifying the emerging opportunity for peripheral vascular disease care for your organization.

What is PVD?

PVD is a condition in which the arteries that carry blood throughout the body become narrowed or clogged. This interferes with the normal flow of blood and can cause pain, physical limitations and reduced quality of life.

The most significant risk factors for PVD is age. The older population is projected to double over the next 30 years, reaching 70 million by 2030, escalating the demand for PVD care. A national study: PAD Awareness, Risk and Treatment—New Resources for Survival (PARTNERS published in the Journal of the American Medical Association, JAMA September 19, 2001) found that PVD is seriously under-diagnosed and under-treated. The American Heart Association and Harvard Health estimate:

300,000 PVD cases are diagnosed each year.

Eight to 10 million Americans are affected.

PVD is two to five times more common in men.

PVD patients have a six-fold higher death rate from cardiovascular disease.

PVD patients have a 15 percent chance of dying within five years when symptomatic.

PVD patients have a 50 percent chance of dying within 10 years from PVD.

What is the PVD Market Opportunity?

The patients at risk for coronary artery disease are the same patients that will be at risk for PVD. The arguments for concentrating efforts on care specific to this patient population makes good business sense—the patient populations are synergistic and currently interventional radiologist, vascular surgeons, primarily care physicians and most recently cardiologists can diagnose and treat the conditions. The increase of patients presenting with symptoms and needing access to care for PVD conditions is anticipated to grow significantly over the next twenty years as shown in Exhibit 1.

Often times, hospital business development and planning departments are charged with defining the market for services and estimating the demand and revenue opportunity. The feasibility models start with identifying the population at risk and applying utilization rates to determine procedure and admission volumes. PVD care has been tracked and measured but estimates are considered to be low because it is believed that older adults have, in the past, lived with their “disability”, accepted limitations and pain with ambulation, and attributed nocturnal leg pain and cramps to “old age”. The demanding “baby boomers” are expected to be less accepting of these disabilities as they become octogenarians.

A reasonable approach to estimating demand:

Review national prevalence and utilization rates that are available from the Vascular Disease Foundation or The Agency for Healthcare Research and Quality

Review state utilization rates, if available, as they will provide a more realistic representation of specific geographic areas

Apply these rates to the population served by the facility, by age group, to obtain the available market estimates as shown in Exhibit 2

Who Treats PVD?

Treatment for PVD can follow three main pathways:

Noninvasive disease management that includes risk-factor reduction, medications to relieve symptoms while increasing exercise tolerance, including gene-based therapy.

Surgical intervention that is safe and effective for many patients in whom less invasive procedures are not adequate.

Catheter-based treatments that have an important and increasing role in the treatment of PVD and are being substituted for surgery.

Primary Care Physicians are often the first provider to identify the problem. Cardiologists may identify PVD during cardiac catheterization procedures. The more complicated issue related to PVD is which specialist should provide treatment once the disease has been diagnosed. Traditionally, interventional radiologists and vascular surgeons have treated patients with advanced stage PVD. With the advancement of catheter-based interventions, cardiologists are increasingly diagnosing and treating PVD in the catheterization lab setting. This shift has set the stage for cultural and political “turf wars” that need to be addressed and resolved if a hospital is to have a full service, integrated program.

What are the Components and Design of a Vascular Center?

The “Vascular Center” can have a distinct physical plant location or can be developed as a “virtual” care model. It is certainly recommended that some or most of the “front door” areas are designed to be patient friendly and centralized with good signage and convenient parking. The majority of the PVD care is outpatient and the population is challenged to walk long distances.

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BIO:

Barbara Sallo, RN, MBA is the President of Health Care Visions, Ltd. a cardiovascular consulting firm based in Pittsburgh, Pennsylvania. The firm brings extensive knowledge and expertise in this area of clinical care. Health Care Visions, Ltd. has assisted a multitude of hospitals in all phases of cardiovascular programs from market assessments, program assessments and feasibility studies to business planning and implementation.

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