Becker's ASC Review

23 Executive Briefing: DVT Prevention in ASCs Sponsored by P ulmonary embolism is the second leading cause of death in the United States, right behind heart disease. Around 300,000 people die each year due to pulmonary embolism, and deep vein thrombosis impacts more than 2 million Americans annually, however; many of these cases are preventable. Healthcare providers know the importance of preventing DVT and associated complications. It has become the standard of care at hospitals to use compression devices such as those offered by Midwest Medical, in addition to best practices for patients to pre- vent post-surgical blood clots. Now, with more ambulatory surgery centers hosting higher acu- ity orthopedics cases, DVT prevention protocol is more important than ever. The compression technology traditionally was expen- sive and cumbersome, but with procedures moving quickly into the outpatient setting, the technology is evolving to include prod- ucts such as Midwest Medical's DVTLite/Venowave that improve on the following: • Fewer wires • Easier portability • Bedside accessibility • Cost-effectiveness Standard of care The DVT protocols and prevention are relatively new for ambula- tory surgery centers. A decade ago, DVT prevention wasn't the standard of care and providers only used the compression de- vices with high-risk cases, which often weren't performed in the ASC. Now, however, new studies show compression devices are important for all at risk patients and accrediting bodies are de- manding them for around 85 percent of admission. "The only ones who aren't getting compression are the small number of patients who are not at risk for DVT," says Midwest Medical CEO Richard Parker. "Accrediting agencies would like to see every patient scored with the Caprini risk assessment tool. The AAAHC has a patient safety toolkit and within the toolkit is this DVT risk assessment tool. AAAHC is encouraging ASCs to assess every patient upon admission." There are around 30 risk factors and most patients present with three to five of the factors, meaning compression would be within the best practices. There are several guidelines built around DVT risk assessment and prevention from organizations such as the American College of Chest Physicians and American Academy of Orthopaedic Surgeons. Hospitals are paying even more attention to DVTs over the past few years since Medicare placed DVT on the "Never Events" list. Medicare won't reimburse for items on the "Never Events" list, so hospitals lose money treating patients with those conditions. "It's gotten to the point that Medicare won't pay for the readmis- sion of DVT because they say it should never happen for cer- tain orthopedic procedures," says Mr. Parker. "The big insurers are saying they won't pay either. That's really driving the market because hospitals don't like to pay penalties. What was once a profit center — readmissions for DVTs — is now a cost. ASCs understand that as well and they don't want to risk penalties in the future." High-risk patients According to the Centers for Disease Control, around one-half of the people who have DVT have long term complications, includ- ing swelling, pain, discoloration and scaling in the affected limb. Around 33 percent of the patients with DVT/PE have recurrence within 10 years. The Nationwide Inpatient Sample developed through the Agency for Healthcare Research and Quality's Healthcare Cost Utiliza- tion Project found venous thromboembolism diagnosis was 2.4 percent overall among adult hospitalizations. Mobile Compression Post-Discharge as the Next Frontier "Accrediting agencies would like to see every patient scored with the Caprini risk assessment tool. The AAAHC has a patient safety toolkit and within the toolkit is this DVT risk assessment tool. AAAHC is encouraging ASCs to assess every patient upon admission." — Richard Parker, Midwest Medical CEO

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