Is Capnography Monitoring Worth the Cost?

Incidents of respiratory compromise ― respiratory insufficiency, failure, and arrest ― pose a genuine threat to your patients and your healthcare facility. Waveform capnography monitoring can help detect the signs of respiratory compromise, so you can intervene when needed. When researching whether to invest in capnography, it’s important to consider these factors: 
  • The health benefit to the patient
  • The financial impact to your bottom line
  • Costs associated with monitors, sampling lines, and warranties
  • Availability of purchasing programs
  • Maintenance and calibration fees
  • Reimbursement options 
In this article, we’ll help you determine whether capnography monitoring is right ― and worth the cost ― for your healthcare organization.

The Business Case for Capnography

A growing number of clinical societies now recommend the use of continuous capnography monitoring in many areas of care: 
  • The American Heart Association (AHA) calls for capnography monitoring to monitor quality of chest compressions, to confirm endotracheal tube placement, and to use as an early indicator of the return of spontaneous circulation (ROSC). 1,2 
  • The American Society of Anesthesiologists (ASA) recommends supplementing visual monitoring with the use of pulse oximetry and capnography for patients under moderate to deep sedation. 3
  • The Anesthesia Patient Safety Foundation (APSF) recommends continuous monitoring of oxygenation and ventilation to help reduce the likelihood of unrecognized, clinically significant opioid-induced respiratory depression. 4
In 2016, an analysis of 44,551 acute respiratory events revealed a mortality rate of 39.4 percent. 5 Another analysis projects cases of respiratory compromise will increase 31 percent by 2019.6  That being said, consider how many adverse respiratory events may occur at your institution. Leveraging capnography monitoring can reduce the likelihood of respiratory compromise while positively impacting your bottom line.
 
Mean costs of adverse respiratory events in procedural sedation include7:
  • Prolonged apnea: $394
  • Mild desaturation: $463
  • Severe desaturation: $529
The average cost per episode of respiratory failure is $53,502, according to HealthGrades estimates.8 Routine use of capnography monitoring may:
  • Reduce the cost per gastrointestinal endoscopy procedure by $858
  • Generate an average annual cost avoidance of $304,2349
Consider these published rates and estimated costs for various types of respiratory failure.10,11 
 
 
 

What Equipment Will I Need?

A capnography monitoring setup includes two major components: the monitor and the sampling line. When evaluating your capnography monitoring needs, ask these key questions:
  • Will I need to purchase a new monitor(s), or will I use sampling lines with my institution’s current multiparameter monitors?
  • Does the sampling line I use have most components integrated, or will I need to purchase accessories such as small-scale fluid fittings to make leak-free connections and water traps?

Multiparameter Monitors (MPM) Versus Bedside and Portable Monitors

Multiparameter monitors provide a variety of information on one screen to help you understand a patient’s condition. You can purchase refurbished MPMs for about $6,000, and new monitors average $7,000 to $12,000. However, high-end monitors can cost up to $35,000. 
 
If you’re looking to leverage a bedside or portable monitor, prices range from $3,750 to $5,400.

Sampling Lines

Not all sampling lines are created equal. You’ll want to choose the right sampling line for each patient. Costs may vary depending on what works best for your needs. On average, sampling lines cost $2 to $15 per patient and are single-patient use.
 
Some manufacturers may offer more scaled-down, economical capnography monitors, but the sampling lines may be more expensive. Other sampling line options also may require additional adaptors, increasing the costs. Our sampling lines are integrated and may require fewer adaptors than other sampling lines. For example:
 
 
It’s important to choose a monitor built for durability and longevity. Some monitors require more frequent replacement. Other monitors are designed to withstand drops and feature an IP54 water resistance rating to protect against dust and splashing water.

Are Purchasing Programs Available?

Every institution is different. To meet your individual needs, you may want to consider a purchasing program. For example, through our Co-Op agreement you’ll receive our monitors at no cost when you commit to future sampling line purchases. We also offer an Equipment Placement Program (EPP): you use our monitors and we provide no-cost maintenance when you commit to future sampling line purchases.

What Is the Warranty Coverage?

The average warranty for capnography solutions is typically one year, with some providers offering up to five years. Be sure you know before purchasing what is and isn’t included. For example, most warranties don’t include: 
  • Sampling lines
  • Damage caused by misuse or neglect
  • Accident or causes external to product (i.e., drops or faulty electrical power)
  • Product on which serial number or lot code has been removed or made illegible
  • Product or part thereof that has been disassembled, serviced, reassembled, or modified by anyone other than the seller
  • Reuse of a product sold for single use
  • Performance of preventive maintenance
Some of these items ― such as accidental damage from electrical surges, unintentional breakage, and drops and falls ― can be covered by an extended coverage service agreement. These typically can be purchased as one- to five-year service contracts.

Is Maintenance and Calibration Required? What Is the Cost?

New capnography technology-enabled monitors are usually factory calibrated before delivery. After installation, an initial calibration should be performed at 1,200 operating hours. After the initial calibration, biomedical/clinical engineering should perform calibration every 4,000 operating hours or annually, whichever comes first. 
 
CO2 calibration gas, which most institutions already have available, can be used to calibrate capnography monitors. If your institution does not have CO2 calibration gas, you can order calibration kits from Scott Medical. The calibration kit retail cost is $536.

Is Capnography Monitoring Reimbursed?

Quality measures are becoming increasingly important as they become tied to potential payment models. And we know patients use publicly available information on hospital quality to decide where to find care.
 
Reimbursement Coding. Capnography devices typically are not separately reimbursed in a hospital setting under ICD-10-PCS. Instead they are reimbursed under a bundled Diagnosis-Related Group (DRG) payment methodology. In some isolated cases, capnography may be separately coded when performed outside the operating room. For example, in the ICU the physician may assign a separate code when personally interpreting the values; it may be paid together with hospital and critical care codes. The CPT code is 94770. To learn more, click here to download the Advanced Monitoring Parameters Reimbursement Guide.
 
Quality Measures. The Centers for Medicare and Medicaid Services (CMS) has implemented pay-for-reporting (P4R) and pay-for-performance (P4P) programs focused on hospital inpatient and long-term care settings. CMS evaluates performance using quality measures. You may tie capnography to quality measures in three specific ways:
  • PSI #90: Composite Measure Patient Safety (PSI) for Selected Indicators — This measure includes postoperative respiratory failure and pulmonary embolism. Capnography is recognized as the fastest method for detecting changes associated with ensuing respiratory failure. There are several composite measures included in PSI #90 as a weighted measure.
  • PSI #04: Death Rate Among Surgical Inpatients with Serious Treatable Complications — Capnography may improve postoperative outcomes in situations that could have otherwise been fatal.
  • Ambulatory Surgical Center (ASC)-4: Hospital Transfer Admission — Capnography may be used to recognize changes in respiratory status and as an early indication of airway compromise.

Capnography Monitoring Cost in a Hospital

When you consider all the factors involved in the cost of capnography monitoring — as well as the cost of not using capnography — you’ll see that the average cost to monitor patients will vary based on the size of your hospital. For example, if an institution implements a protocol to monitor every patient in the IR suite and performs 10 IR cases a day, the annual cost of capnography monitoring will be $36,500 at $10 per patient. 
 

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References:

1. Field JM, Hazinski MF, Sayre MR, et al. Part 1: Executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 suppl 3):S640–S656.
2. Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult advanced cardiovascular life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 suppl 2):S444–S464.
3. Committee of Origin: Standards and Practice Parameters. Standards for Basic Anesthetic Monitoring. American Society of Anesthesiologists Website. https://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards-for-basic-anesthetic-monitoring.pdf. Last affirmed on Oct. 28, 2015. Accessed Oct. 31, 2017.
4. Stoelting RK, Overdyke FJ. Essential Monitoring Strategies to Detect Clinically Significant Drug Induced Respiratory Depression in the Postoperative Period Conclusions and Recommendations. Anesthesia Patient Safety Foundation Website. https://www.apsf.org/newsletters/pdf/fall_2011.pdf. Updated Sept. 26, 2015. Accessed Dec. 7, 2017.
5. Andersen LW, Berg KM, Chase M, et al. Acute respiratory compromise on inpatient wards in the United States: incidence, outcomes, and factors associated with in-hospital mortality. Resuscitation. 2016;105:123–129.
6. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population, 2019. Abstract presented at: Academy Health Congress; June 2011; Seattle.
7. Yan JW, McLeod SL, Iansavitchene A. Ketamine-propofol versus propofol alone for procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2015:22(9):1003–1013.
8. Jopling M, Heard L, Kofol T, Warner E. Evaluating the cost-effectiveness of capnography monitoring in procedural sedation: a gastroenterology (GI) suite cost-avoidance model. Gastrointestinal Endoscopy. 2015;81(5S):AB193. Health Grades Patient Safety in American Hospitals Study. March 2011. Available at http://patientsafetymovement.org/wp-content/uploads/2016/02/Resources_Reports_Patient_Safety_in_American_Hospitals_Study.pdf.
9. Saunders R, Erslon M, Vargo J. Modeling the costs and benefits of capnography monitoring during procedural sedation for gastrointestinal endoscopy. Endosc Int Open. 2016;4(3):E340–E351.
10. Saunders R, Davis JA, Kranke P, Weissbrod R, Whitaker DK, Lightdale JR. Clinical and economic burden of procedural sedation-related adverse events and their outcomes: analysis from five countries. Ther Clin Risk Manag. 2018;28;14:393–401.
11. Saunders R, Struys MMRF, Pollock RF, Mestek M, Lightdale JR. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. BMJ Open. 2017;30;7(6):e013402.

TOPIC: Microstream™ Capnography MonitoringProcedural Sedation

About the Author

Michael Noble

Michael Noble is a Market Strategist for the Medical-Surgical and Procedural Sedation areas of care in the hospital at Medtronic. He develops strategies to help clinicians ensure patient safety with continuous monitoring solutions like Microstream™ capnography, Nellcor™ pulse oximetry, and Vital Sync™ clinical decision support.

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