Catheterization and Cardiovascular Diagnosis 27:164 (1992)
Letters to the Editor Mobile Catheterization Laboratories TO THE EDITOR In the May issue of Catheterization and Cardiovascular Diagnosis an editorial by Dr. David Holmes and the Trustees of the Society for Cardiac Angiography and Interventions [ l ] was published regarding mobile catheterization laboratories. Our understanding of the editorial conclusion is that although there may be some theoretical advantages to mobile cath labs, the “major drive is marketing of services”. Dr. Holmes states that “although there may be exceptions, in general, the disadvantages outweigh the advantages”. He suggests that mobile catheterization laboratories have the effect of causing an inappropriate proliferation of this service because of the problem of “keeping up with the Jones” philosophy. While we do not entirely disagree with the comments made by Dr. Holmes, we find it ironic that one month earlier, in the April 20th, issue of Medical Economics, an article entitled “How Mega Clinics are Building Competitive Clout”, described the Mayo Clinic as markedly expanding its outreach efforts, in part through the development of a mobile catheterization laboratory to serve hospitals in the region. Since Dr. Holmes practices at the Mayo Clinic, one would wonder why the negative comments voiced in this editorial, when his own institution explored the possibility and then actually started a mobile catheterization laboratory service. We should avoid creating a double-standard in the practice of medicine in this country. Our leaders should be careful to practice what they preach. The same arguments against mobile cath labs for cardiologists in general, should certainly hold for the practices of those cardiologists opposing mobile cath services. We would be interested in your comments.
Louis McKeever, MD Joseph C. Marek, MD Midwest Heart Specialists Midwest Cardiovascular Inst.itute Downers Grove, Illinois
REFERENCE 1. Holmes, Jr DR, The Trustees of the Society for Cardiac Angiography and Interventions: The Mobile Catheterization Laboratory: Should we pick it up and move it? Cathet Cardiovasc Diagn 26:69-70, 1992.
Mobile Catheterization Laboratories REPLY The letter by Drs. McKeever and Marek concerning mobile catheterization facilities raises some important issues. There are 0 1992 Wiley-Liss, Inc.
potentially multiple conclusions that could be drawn from the editorial. There are numerous reasons for mobile catheterization laboratories as elucidated in the editorial. One of the reasons may be an attempt to optimize resources; rather than expand small volume fixed catheterization laboratories, a mobile laboratory may be advantageous in this regard. Perhaps the major drive is marketing of services. The thrust of the editorial is that mobile catheterization laboratories exist and the technology allows excellent images to be obtained safely. Most importantly, the conclusion of the editorial stands as written [l] that “Given that such laboratories exist, we can only hope that prospective scientific data on socioeconomic costs as well as safety and efficacy are being gathered so that the end of a finite time period cardiology can address the specific merits of the application of this technology in order to decide (and then legislate if necessary) when and if it should be continued or if it should be abandoned and replaced with attempts to maintain easier access for patients to cardiac laboratories in more traditional and established settings.” The authors are correct in stating that the Mayo Clinic does indeed have a mobile catheterization laboratory. Considerable concern was raised at our institution about this, both by the consulting staff and our board of governors, as there is concern about unchecked proliferation of medical resources. In Rochester, we have taken the stance that this technology exists and may play a role in health care delivery. Accordingly we have been given a three year time trial to evaluate safety (which is excellent), costs, both direct and indirect from our institution as well as from the regional centers involved, and finally acceptance by the referring physicians and patients. At the end of the three years we will be able to identify the role of the mobile catheterization laboratory, at least in our own geographic area. If it results in actual improved health care delivery, it will be continued or expanded; alternatively, if it adds little, the equipment can easily be used in a fixed laboratory. Evaluation of new technology is important, whether it may be new diagnostic modalities or new therapeutic devices. The goals of such evaluation are to decide the optimal role of health care delivery for the specific patient. To that end, careful evaluation of the merits and or potential dements of the mobile catheterization laboratory is an important and a reasonable goal.
David R . Holmes, J r . , M D Division of Cardiovascular Diseases Mayo Clinic Rochester, Minnesota
REFERENCES 1. Holmes, Jr DR, The Trustees of the Society for Cardiac Angiography
and Interventions: The Mobile Catheterization Laboratory: Should we pick it up and move it? Cathet Cardiovasc Diagn 26:69-70, 1992.
Letters to the Editor Mobile Catheterization Laboratories TO THE EDITOR In the May issue of Catheterization and Cardiovascular Diagnosis an editorial by Dr. David Holmes and the Trustees of the Society for Cardiac Angiography and Interventions [ l ] was published regarding mobile catheterization laboratories. Our understanding of the editorial conclusion is that although there may be some theoretical advantages to mobile cath labs, the “major drive is marketing of services”. Dr. Holmes states that “although there may be exceptions, in general, the disadvantages outweigh the advantages”. He suggests that mobile catheterization laboratories have the effect of causing an inappropriate proliferation of this service because of the problem of “keeping up with the Jones” philosophy. While we do not entirely disagree with the comments made by Dr. Holmes, we find it ironic that one month earlier, in the April 20th, issue of Medical Economics, an article entitled “How Mega Clinics are Building Competitive Clout”, described the Mayo Clinic as markedly expanding its outreach efforts, in part through the development of a mobile catheterization laboratory to serve hospitals in the region. Since Dr. Holmes practices at the Mayo Clinic, one would wonder why the negative comments voiced in this editorial, when his own institution explored the possibility and then actually started a mobile catheterization laboratory service. We should avoid creating a double-standard in the practice of medicine in this country. Our leaders should be careful to practice what they preach. The same arguments against mobile cath labs for cardiologists in general, should certainly hold for the practices of those cardiologists opposing mobile cath services. We would be interested in your comments.
Louis McKeever, MD Joseph C. Marek, MD Midwest Heart Specialists Midwest Cardiovascular Inst.itute Downers Grove, Illinois
REFERENCE 1. Holmes, Jr DR, The Trustees of the Society for Cardiac Angiography and Interventions: The Mobile Catheterization Laboratory: Should we pick it up and move it? Cathet Cardiovasc Diagn 26:69-70, 1992.
Mobile Catheterization Laboratories REPLY The letter by Drs. McKeever and Marek concerning mobile catheterization facilities raises some important issues. There are 0 1992 Wiley-Liss, Inc.
potentially multiple conclusions that could be drawn from the editorial. There are numerous reasons for mobile catheterization laboratories as elucidated in the editorial. One of the reasons may be an attempt to optimize resources; rather than expand small volume fixed catheterization laboratories, a mobile laboratory may be advantageous in this regard. Perhaps the major drive is marketing of services. The thrust of the editorial is that mobile catheterization laboratories exist and the technology allows excellent images to be obtained safely. Most importantly, the conclusion of the editorial stands as written [l] that “Given that such laboratories exist, we can only hope that prospective scientific data on socioeconomic costs as well as safety and efficacy are being gathered so that the end of a finite time period cardiology can address the specific merits of the application of this technology in order to decide (and then legislate if necessary) when and if it should be continued or if it should be abandoned and replaced with attempts to maintain easier access for patients to cardiac laboratories in more traditional and established settings.” The authors are correct in stating that the Mayo Clinic does indeed have a mobile catheterization laboratory. Considerable concern was raised at our institution about this, both by the consulting staff and our board of governors, as there is concern about unchecked proliferation of medical resources. In Rochester, we have taken the stance that this technology exists and may play a role in health care delivery. Accordingly we have been given a three year time trial to evaluate safety (which is excellent), costs, both direct and indirect from our institution as well as from the regional centers involved, and finally acceptance by the referring physicians and patients. At the end of the three years we will be able to identify the role of the mobile catheterization laboratory, at least in our own geographic area. If it results in actual improved health care delivery, it will be continued or expanded; alternatively, if it adds little, the equipment can easily be used in a fixed laboratory. Evaluation of new technology is important, whether it may be new diagnostic modalities or new therapeutic devices. The goals of such evaluation are to decide the optimal role of health care delivery for the specific patient. To that end, careful evaluation of the merits and or potential dements of the mobile catheterization laboratory is an important and a reasonable goal.
David R . Holmes, J r . , M D Division of Cardiovascular Diseases Mayo Clinic Rochester, Minnesota
REFERENCES 1. Holmes, Jr DR, The Trustees of the Society for Cardiac Angiography
and Interventions: The Mobile Catheterization Laboratory: Should we pick it up and move it? Cathet Cardiovasc Diagn 26:69-70, 1992.
