Peripheral occlusive disease may provide the highest hospital margins despite rising costs


      The objective of this study was to review vascular surgical financial trends in a tertiary care setting and to evaluate the impact of a vascular program within a health care system in the face of lower reimbursements and rising costs.


      With use of Current Procedural Terminology codes and diagnosis-related groups, vascular categories of aortic disease, cerebrovascular disease, and peripheral occlusive disease (POCD) were identified at an academic tertiary health care center. Hospital margins were calculated for each of the defined categories by Health Quest cost accounting data cross-walked with Current Procedural Terminology codes, date of service, and admitting physician for each year from 2010 to 2012.


      All categories realized volume growth and a positive margin for the hospital. In comparison of 2010 and 2012, aortic cases showed an overall volume growth of 19%, revenue increase of 31%, and cost increase of 54%, resulting in an overall margin decrease of 7%. Cerebrovascular cases showed a 30% increase in volume growth, revenue increase of 13%, and cost increase of 5%, resulting in a margin increase of 18%. POCD cases showed overall volume growth of 35%, revenue increase of 37%, cost increase of 54%, and a margin increase of 15%. The margin for POCD exceeded the margin for aortic and cerebrovascular cases combined by 77%.


      In evaluating a vascular program's fiscal viability, volume-driven POCD was the only category producing growing hospital margins in the face of significant cost increases.
      To read this article in full you will need to make a payment
      SVS Member Login
      Society Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Roddy S.
        • O'Donnell T.
        • Wilson A.
        • Estes J.
        • Mackey W.
        The Balanced Budget Act: potential implications for the practice of vascular surgery.
        J Vasc Surg. 2000; 31: 227-236
        • Satiani B.
        Use, misuse, and underuse of work relative value units in a vascular surgery practice.
        J Vasc Surg. 2012; 56: 267-272
        • Zwolak R.
        • Trout H.
        Vascular surgery and the resource-based relative value scale five-year review.
        J Vasc Surg. 1997; 25: 1077-1086
        • Jain K.
        • Munn J.
        • Rummel M.
        • Vaddineni S.
        • Longton C.
        Future of vascular surgery is in the office.
        J Vasc Surg. 2010; 51: 509-514
        • Roddy S.
        • O'Donnell T.
        • Iafrati M.
        • Isaacson L.
        • Bailey V.
        • Mackey W.
        Reduction of hospital resources utilization in vascular surgery: a four-year experience.
        J Vasc Surg. 1998; 27: 1066-1077
        • O'Brien-Irr M.
        • Harris L.
        • Dosluoglu H.
        • Dayton M.
        • Dryjski M.
        Lower extremity endovascular interventions: can we improve cost-efficiency?.
        J Vasc Surg. 2008; 47: 982-987
        • Matthews M.
        • Satiani B.
        • Lohr J.
        Trends in a changing vascular practice environment for members of the Society for Vascular Surgery.
        J Vasc Surg. 2011; 57: 586-592
        • Martin J.
        • Warble P.
        • Hupp J.
        • Mapes J.
        • Stanziale S.
        • Weiss L.
        • et al.
        A real world analysis of payment per unit time in a Maryland Vascular Practice.
        J Vasc Surg. 2010; 52: 1094-1099
        • Taylor N.
        • Lombardi J.
        • Toddes S.
        • Alexander J.
        • Trani J.
        • Carpenter J.
        An all-inclusive and transparent view of a vascular program’s direct impact on its health system.
        J Vasc Surg. 2012; 55: 281-285
        • Taheri P.
        • Butz D.
        • Dechert R.
        • Greenfield L.
        How DRGs hurt academic health systems.
        J Am Coll Surg. 2001; 193: 1-11
        • Stone D.
        • Horvath A.
        • Goodney P.
        • Rzucidlo E.
        • Nolan B.
        • Walsh D.
        • et al.
        The financial implications of endovascular aneurysm repair in the cost containment era.
        J Vasc Surg. 2014; 59: 283-290