Prospective reimbursement for state-of-the-art medical practice: the case for invasive electrophysiologic evaluation

This study is an examination of the economic consequences of invasive electrophysiologic (EP) evaluation for recurrent supraventricular tachycardia (SVT) and ventricular tachycardia (VT) on a tertiary health care facility during 1980 and 1981. The average cost of hospitalizations for EP evaluation was substantial (SVT, $6,990; VT, $13,897), as was the length of hospital stay (SVT, 12 +/- 8 days; VT, 24 +/- 8 days). The cost of a single EP procedure in the study period averaged $695 (range $200 to $1,206). During follow-up (1 to 3 years), there was substantial improvement in arrhythmia control on EP-based therapy in SVT and VT compared with prior empirical therapy. Cost:benefit analysis strongly favored EP-based therapy over empirical therapy (SVT, 6:1; VT, 18:1) in this follow-up period. Comparison with cost of noninvasive techniques for VT evaluation showed that EP evaluation had comparable cost. Current prospective reimbursement schedules have no DRG category for EP evaluation and do not fairly compensate hospitals for invasive or noninvasive arrhythmia studies. Invasive EP evaluation is both clinically effective and cost-effective in the management of patients with recurrent SVT and VT. Prospective reimbursement plans should include a specific DRG category for these studies.