From the March 2013 issue of HealthCare Business News magazine
It’ still quite a niche market – the Advisory Board said of surveyed hybrid OR sites, only 32 percent used it for TAVR – but it’s on the upswing. A MD&DI article from last summer said the market size (for the devices) could be as high as $2.5 billion.
“We’re seeing large institutions doing it, but small institutions are looking ahead even if they don’t have a program today,” Toshiba’s Berthe says. “The (hybrid) rooms are built for probably a 10-year lifespan.”
Importantly perhaps for the future of hybrid ORs, the Centers for Medicare and Medicaid Services says having one is one way to meet the (many) conditions for reimbursement for TAVR procedures.
In its guidelines, in fact, the CMS specifies having a fixed angiography system with flat-panel fluoroscopy for coverage. The problem with mobile C-arms is that they are not powerful enough to visualize key vascular features, and they can’t do continuous fluoroscopy for a long enough time because they risk overheating, and shutting down, Kulkarni says. “They sometimes put ice bags on tubes [to cool them], but you can’t do this if you’re doing a procedure which could potentially be life-threatening.”
The OR is also the biggest revenue generator in a hospital, and in Europe at least, adding hybrid capacities could make the rooms more efficient. While 42 percent of a European hospital’s revenues come from the OR, they’re generally only running at 68-70 percent capacity, Frost & Sullivan’s Eramangalath says. Hybrid ORs could help boost those volumes through multidisciplinary sharing.
But the hybrid OR is not, of course, the answer for all procedures.
“Honestly, the way we think about it is the right case in the right room,” says Dr. Lumsden, who incidentally was invited to give a talk on hybrid OR planning at the Transcatheter Valve Therapies conference 2013 in Vancouver in June. He says diagnostic and basic angiograms are potentially better suited for the cath lab, and the hybrid OR should be reserved for a mix of open and endovascular procedures.
His own hybrid OR runs at 80 to 90 percent capacity, but it takes a lot of planning and smart scheduling to do that, especially as TAVR procedures take up a little more than one day a week.
“TAVR has given us a challenge,” he says, because of the rising caseloads in their hybrid OR. “We’re looking at building another one.”
If his hospital does, it should expect to shell out a pretty penny.
“The cost equation”
Minimally invasive techniques might be driving demand for hybrid ORs, but hospitals mulling over designing one of these rooms face several hurdles. A major one is cost. A typical hybrid suite runs between $3 million and $9 million, according to Frost and Sullivan’s Eramangalath, and installation costs for greenfield suites start at $4 million. Hybrid ORs are also bigger than their traditional counterparts. It varies from country to country, but a typical OR is between 700 and 900 square feet, Eramangalath says, while a hybrid OR usually requires as much as 1,000 to 1,200 square feet.
