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The case for ultrasound in an era of health care reform

March 24, 2014

DMN: In terms of point-of-care for vascular access procedures, obviously ultrasound, as you point out, is in a strong position to bring down health care costs, which is supported by analysis from AHRQ and other organizations. What are, in your view, the cost drivers here in terms of quality, safety, and procedure efficiencies and cost? What are the core drivers?
KG: You mention the study by the Agency for Healthcare Research and Quality in 2001, really a sentinel study regarding documenting how real-time ultrasound guidance for CVC insertion improves catheter insertion success rates, reduces the number of venipuncture attempts prior to successful placement, and reduces the number of complications associated with catheter placement.

A major complication of line placements, pneumothorax, is substantially reduced when ultrasound is used to guide the placement of the line. And while it took some time for the medical societies and others' guidelines to catch up regarding recommending the use of ultrasound to guide vascular access, they have, and now the Centers for Medicare and Medicaid Services includes pneumothorax at the time of venous access in their hospital acquired conditions program.

SonoSite and United Bio Source did a study together that was published in the journal CHEST, which demonstrated that the increased cost per hospital stay of a pneumothorax was $2,752 and the LOS increased by 1.4 days when the patient suffered this complication. Institutions that have integrated the use of ultrasound guidance have reduced this complication to zero.

DMN: The Ultrasound First campaign seems to be getting some traction. Can you elaborate just a bit on the aim of the education effort and the potential impact it could have on the nation's health care system?
KG: "Ultrasound First" actually came from a number of frontline physicians in emergency medicine, critical care, and orthopedic sports medicine. We listened to these physicians saying, "I couldn't imagine practicing without ultrasound at the frontline and when I do I end up saving a lot of time and money in ways that are very simple and easy to follow." After hearing this refrain from them, we at SonoSite took it forward to various stakeholders in the health care system. It has savings potential in the billions of dollars and applies to many specialties.

DMN: Can you give a "for instance"?
KG: Yes, we now see in orthopedic care an opportunity that is literally right under the noses of the payers. If they were encouraging frontline use, even with fee-for-service, and there were protocols that dictated the follow-on activities under different clinical conditions, the savings would be immense. Looking at emergency room and critical care, we know of two institutions on the west coast that have employed ultrasound at the point-of-care to get things done visually without going to X-rays and other tests or labor-intensive tasks. One is USC / L.A. County Hospital. The other is UCLA Critical Care, where the leading physician there has told us she saves three dollars for every one she spends on ultrasound used at the point-of-care. These are real examples and real savings. There are many instances where you would get tremendous cost advantages on the very first day of implementing an "ultrasound first" protocol.

DMN: How likely is that to happen on a broad scale?
KG: The issue is that there are people who want to fight for continued use of MRI and CT, even in situations when physicians say it is simply not needed. But more and more, physicians are able to move patients forward more safely and more efficiently using ultrasound-and those results speak for themselves.

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