Atlanta Business Chronicle - February 11, 2002
. http://atlanta.bizjournals.com/atlanta/stories/2002/02/11/focus10.html
From the February 8, 2002 print edition
Bloodless surgery cuts hospital stay and bills
Ray Glier
Contributing Writer
You've heard the horror stories, or else you've seen the horrific bills up close and too personal. Just a one-day stay in a hospital can give you yearlong sticker shock.
But what if you could trim a day off that stay in the hospital? What if the seven-day stay at approximately $3,500 a day was trimmed to six days or even five?
Imagine the savings to you and the glee on the face of your insurance company.
One of the advantages of the "bloodless" medicine program at Atlanta Medical Center is it can get you out of the hospital faster. In bloodless surgery, a patient does not use transfusions of banked blood during an operation, thus reducing the risk of infection and further problems.
During bloodless surgery, physicians reduce blood loss by using laser and harmonic scalpels, argon beam coagulators and drugs that help minimize blood loss.
"Bloodless surgery allows a patient to recover a lot faster because of not having a foreign body added to their system to suppress their immune system," said Melvin Satterfield, the program administrator of Atlanta Medical Center's bloodless surgery program. "One of the complications of a blood transfusion is an added hospital stay."
Cost savings
Shorter hospital stays mean less for the insurer to pay.
"Just think if a person had a double or triple bypass," Satterfield said. "If you can cut a couple of days off that length of stay, then just divide that by the $50,000 or $60,000 cost of the stay, you can see the savings."
There is no distinction in reimbursement to hospitals when insurance companies handle bloodless medicine claims, said Deborah Tolich, director of the bloodless medicine program at St. Vincent Charity Hospital in Cleveland.
Savings aren't just realized by a patient's shorter stay in the hospital.
"A lot of people don't realize the cost of blood, the cost of storage, the administrative cost, the cost of cross-matching," Satterfield said. "There are some that are considered indirect cost. There is reduced cost of medication because sometimes the medication a person might take is to fight an infection from their body being suppressed by the foreign blood."
The cost of bloodless medicine procedures compared with transfusion procedures can be the same or significantly lower, Tolich said. The actual costs depend on the procedure.
Atlanta Medical Center has a full menu of surgeries in its bloodless medicine program including open-heart, heart bypass, hip replacement and cancer removal. Even the most complicated of surgeries like the "Whipple," where organs have to be disconnected and moved, can be done without a blood transfusion.
Atlanta Medical Center already had several pieces of general surgical equipment in place when it started its bloodless medicine program two years ago. One piece of equipment that must be purchased is called a cell saver, which typically costs between $5,000 and $10,000.
Religious accommodations
The bloodless technique was developed approximately 60 years ago by doctors treating Jehovah's Witnesses. For religious reasons, such patients do not accept blood transfusions, so techniques were developed to minimize blood loss.
The Jehovah's Witnesses' position is a non-negotiable stance outlined on the group's Web site ( http://www.watchtower.org), which states, "Those who respect life as a gift from the Creator do not try to sustain life by taking in blood."
Ninety percent of Atlanta Medical Center's patients use the surgery for religious purposes, said Dr. Edward "Mac" Mason, general surgeon and medical director of the center's Bloodless Medicine program. But, in other cities, the mix becomes 50-50 once the program becomes more well-known. Houston, Chicago, Cleveland and Los Angeles are other cities with advanced programs in bloodless medicine.
From a surgeon's point of view, the bloodless medicine technique makes perfect sense in terms of the health of a patient following surgery.
"We know that in certain types of illnesses, the long-term effect of giving blood is harmful," Mason said. "We've known for a long time that patients who have had surgery for colon cancer and receive blood don't have as good a survival rate as those patients who don't receive blood. When you use stored blood, you are using a lot of factors than can complicate the surgery, both from a respiratory point of view and the kidney point of view."
The bloodless technique used by hospitals does not involve a heavy commitment to retraining doctors or sending them off to school.
"Bloodless medicine is really a no-brainer," Tolich said. "You teach doctors how to limit lab draws and how to prevent patients from getting severely anemic. The hardest part in the training is to get them to limit their transfusion trigger so they aren't running for blood."
Many hospitals mistakenly think they are practicing bloodless medicine techniques, said Tom Johnson, president of Autologous Blood Resources Inc. of Lawrenceville.
"They're not," he said. "They don't understand how it all fits together. They think they are using less blood, but they could do even more. It goes outside the operating room. It involves laboratory, how lab samples are handled, how a patient is prepped for surgery, how there are medications that are given to them so they would not have to get blood in the surgery."
Copyright 2002 American City Business Journals Inc.