Sharing Cardiac Catheterization Services:

A Way to Improve Patient Care and Reduce Costs

HRD-78-14: Published: Nov 17, 1977. Publicly Released: Nov 17, 1977.

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Cardiac catheterization is a procedure used to diagnose possible heart conditions. It is performed in 90 Federal hospitals: 66 Veterans' Administration (VA) facilities; 20 Department of Defense (DOD) facilities; 3 Public Health Service hospitals; and the National Institutes of Health clinical center in Bethesda, Maryland. Several medical professional organizations, as well as the VA, have developed quidelines for cardiac catheterization laboratories. These guidelines are intended to keep physicians' skills high and to minimize risk to patients. DOD and the Public Health Service have no such guidelines.

The number of cardiac catheterizations being performed in DOD and VA laboratories varied considerably. For fiscal year 1976, catheterizations performed at the Federal hospitals reviewed ranged from 574 at Walter Reed in Washington, D.C., to 60 procedures at Wright Patterson in Dayton, Ohio. Also, there was no correlation between the number of catheterizations performed and the number of physicians performing them. In addition, physicians at the hospitals had differing views of the number of catheterizations that should be performed to maintain their proficiency. In each of four geographic areas visited, there were opportunities to provide cardiac catheterization on a shared basis which could increase patient safety and reduce costs to the Government. The sharing opportunities could be accomplished within the framework of present laws governing DOD and VA operations.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretaries of Defense (DOD) and Health, Education, and Welfare (HEW) and the Administrator of Veterans Affairs (VA) should: (1) jointly develop uniform Federal guidelines for the planning and use of Federal cardiac catheterization laboratories which associate the number of catheterization procedures to be performed with the number of physicians that should perform them; (2) consider what variances from those guidelines might be appropriate; (3) jointly analyze the use levels at the laboratories and adjust the manner in which this diagnostic service is provided, and, where feasible, provide cardiac catheterization on a joint or shared basis in a single Federal facility; and (4) discontinue providing the procedure in Federal facilities in geographic areas where the Federal guidelines cannot be met and obtain this service from nearby civilian hospitals. The Director of the Office of Management and Budget should oversee the offers of DOD, HEW, and the VA in developing uniform Federal guidelines for the planning and use of Federal cardiac catheterization laboratories to insure it is accomplished in an appropriate and timely manner.

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