3-D modeling system designed to support structural heart procedures – Obvious and more subtle implications

October 29, 2019

Use of complex structural cardiac procedures have significantly increased over recent years, expanding options for sicker patients.  Supported by advanced imaging, these procedures by nature are performed without direct cardiac visualization. Now, in yet another application of computer image capture and manipulation, EchoPixel has created a tool designed to create 3D holographic models of the heart to assist in preoperative planning, patent selection and to facilitate more complex structural and congenital heart procedures on adults and pediatric patients.  As described in an article in Health Data Management, the technology which is awaiting FDA clearance, can process and integrate images from CT, MRI, echocardiography and fluoroscopy to create 3D holographic images.  These images, according to Dr. Saurabh Sanon, MD, director of the Structural Heart Transcatheter Therapies program at Palm Beach Gardens Medical Center, as quoted in the article, “lets you effortlessly interact with 3D images to better understand complex cardiac anatomy and the anatomic variability that is commonly seen in structural heart disease patients.”  Dr. Sanon goes on to opine that early results show promise to improve efficiency and patient access to structural heart procedures.   

EHC NOTE: In yet another example of the inexorable march of technology to support patient care, this article highlights advanced holographic imaging as applied to structural cardiac procedures.  While the system is still in the FDA approval process, it is likely that either this or a similar system will eventually be perfected for these procedures.  

In our consulting work, we have seen a dramatic increase in TAVR, Watchman and similar complex procedures.  Properly performed in well-trained hands, this expertise opens new solutions for many patients. At the same time, support of these procedures does require additional equipment as well as nursing, anesthesia and support personnel.  Frequently requiring an additional covered location or two, these resources must be secured and budgeted for. In addition, specialized cath lab or hybrid rooms occupy precious and often scarce hospital square footage.  

As the need for very expensive technology such as 3D holographic systems are perfected and perhaps become the standard of care, the cost to provide these services would be expected to march higher.  

As they seek to best support healthy populations in their markets, the challenge for hospitals and OR leadership is to balance costs and returns and to determine where to invest resources.  Of course, all facilities cannot be everything to everyone. We advise facilities to build on service line strength to create Centers of Excellence from a clinical, operational and efficiency perspective.  It makes little sense to have similar services duplicated or triplicated or quadruplicated in the same narrow geography.  

Favorable reimbursement can allow a relatively low volume practice to thrive.  However, using structural heart as an example, while reimbursement is currently favorable, there will eventually be downward pressure.  If your facility is burdened by expensive equipment, technology, real estate allocation and personnel allocated to this (or any other) specialized service line, the bottom line may eventually come under pressure.  In our opinion, business modeling for such service lines should be “stress tested” for reduced reimbursement, competition, out-migration of patients to tertiary centers etc. Sure, you can repurpose these resources to another service line down the line, but that pivot takes time and requires new investment in personnel and equipment. 

While the tech described in the article discussed has exciting potential for structural heart patients, it should also lead OR and hospital leaders to consider the future implied cost and challenges of certain service lines.  Focus on areas where you have an inherent market advantage or can foresee a long term and sustainable service line which will help improve the health of your population and can withstand “stress test” scenarios.