Developing a cardiopulmonary exercise testing laboratory.

Background: Cardiopulmonary exercise testing is a noninvasive and cost-effective technique that adds significant value to the assessment and management of a variety of symptoms and diseases. The penetration of this testing in medical practice may be limited by perceived operational and financial barriers.
Procedure: This article reviews coding and supervision requirements related to both simple and complex pulmonary stress testing. A program evaluation and review technique diagram is used to describe the work flow process. Data from our laboratory are used to generate an income statement that separates fixed and variable costs and calculates the contribution margin. A cost-volume-profit (break-even) analysis is then performed.
Results: Using data from our laboratory including fixed and variable costs, payer mix, reimbursements by payer, and the assumption that the studies are divided evenly between simple and complex pulmonary stress tests, the break-even number is calculated to be 300 tests per year. A calculator with embedded formulas has been designed by the author and is available on request.
Conclusions: Developing a cardiopulmonary exercise laboratory is challenging but achievable and potentially profitable. It should be considered by a practice that seeks to distinguish itself as a quality leader. Providing this clinically valuable service may yield indirect benefits such as increased patient volume and increased utilization of other services provided by the practice. The decision for a medical practice to commit resources to managerial accounting support requires a cost-benefit analysis, but may be a worthwhile investment in our challenging economic environment.