The budget for an EP lab can be divided up into the “capital budget” which includes equipment, construction and other start-up costs -- and the annual or “operational” budget which will include ongoing costs, such as those related to staffing and supplies.
Disclaimer: Note that manufacturers' names included here are intended to be illustrative and do not constitute an endorsement by the Heart Rhythm Society.
Capital Budget (Start up)
Outpatient admission area
Setting up a 24-hour unit should be considered, as payers may eventually require ≤ 24 hour hospital stays for certain procedures.
- ECG machines
- BP cuffs
- Storage (Pixus) for pharmacy medications
- ± Telemetry equipment (if 24 hour unit)
Recovery area/ holding area
- Defibrillator/crash cart
- Stretchers
- O2 – airway management/suction
- Medication storage
- Telemetry monitoring
- Documentation system (EMR/MAC lab or Cardiolab/Prucka)
- ECG machines
Scheduling system
- Electronic preferred (can track o/p beds, as well as lab schedule)
EP lab equipment
- X-ray system (e.g., Siemens, GE, Philips, Toshiba)
- Recording system (e.g., GE/Prucka/Cardiolab, Philips, Siemens)
- Stimulator (e.g., Bloom/Fisher, GE, Medtronic)
- Mapping system (e.g., CARTO/Boston Scientific, ESI/St. Jude)
- Ablation system (e.g., EPT/Boston Scientific, St. Jude)
- Stereotaxis (Hansen system (GE) vs. Siemens with Biosense Webster, plus magnet and shield for X-ray
- Equipment) vs. Boom to hold X-ray monitors and other monitor screens (e.g., CARTO, ICE)
- Electrocautery/Bovie
- Defibrillators, 2 per lab, biphasic, with at least one high output
- Intravascular ultrasound (e.g. Philips, Siemens/Acuson)
- Crash cart
- Anesthesia equipment
- Anesthesia cart
- Separate monitoring system for hemodynamics plus ecg
- End-tidal CO2 - ACT machine in-lab
- Printer/copier
- Supplies
- Needles
- Sheaths
- Diagnostic catheters
- Mapping/ablation catheters
- Instruments for trays (e.g., pacer and ICD trays)
- ICDs/ppms/implantable loops are typically on consignment; programmers and programmer paper
- Stethoscopes
- Teaching materials (e.g., heart model, books) - Furnishings
- Chairs
- Phones
- IT equipment (e.g., computers for reports, computer lines)
Construction (variable, depending on current space usage)
Capital Cost Estimates
- X-ray: $1.2 million (single plane) - $2.0 million (biplane)
- Stereotaxis: $1.2 million – 10 inputs for Odyssey monitor (Hansen less)
- Prucka plus amplifiers: $250,000
- CARTO merge: $250,000; Image grabber for X-ray (GE system): $46,000
- ESI: $225,000-$250,000
- Defibrillators (biphasic): $8,000-9,000 each
- Anesthesia machine: $140,000 (MRI compatible) vs. $80,000 (regular)
- Bovie: $8,000
- Crash cart: $100,000
- Prep tables: $8,000 each
- Miscellaneous (minor medical equipment/supplies): variable ~$100,000: include stethoscopes, lead aprons, lead glasses, lead shields under table and by RN, disposable supplies, instrument trays for devices (e.g. 5) plus start-up disposable prep trays for EP cases
- Furnishing/phones: variable ~$5000
- IT (PCs, computer lines): variable ~$10,000
- Construction costs: variable, depending on current space usage: ~$250,000 (e.g., more if converting from office space) – will need to consider piping, airflow, etc., if not pre-existing
Annual (Operating) Budget
Staffing (salary and benefits)
Staff to include:
- RNs (~70% of lab staff)
- Techs (~30% of lab staff)
- Support staff (scheduler/transcriptionist/stocking supplies)
Equipment expenses – sub-accounts
- ICD
- PPM & implantable loop monitors
- Diagnostic catheters
- Ablation catheters
- Other medical supplies: tubing, wires, O2, disposable drapes, disposable custom-made pre-packaged trays for EP procedures, instrument trays for devices, additional pieces for device trays as needed, etc.
- Non-medical supplies for office equipment: printer cartridges, ink, paper, computer lines or upgrades, lease line for copier/fax, etc.
Calculating Operating Costs
Staff Costs
Assuming 8 hour shifts, estimate 3 RNs/techs per lab for diagnostic and devices, and 4 RNs/techs per lab for complex ablation procedures (including staff to run ICE and mapping equipment). This includes RNs to administer IV conscious sedation throughout complex procedures, with anesthesia personnel available on a “prn” basis for most cases.
Budget 1.15 for each RN/tech position needed, which includes the assumption of 15% non-productive time to account for sick time and vacations). For example:
- To run a lab with 3 RNs/techs, budget for 3 x 1.15 = 3.45 FTE.
- To run a lab with 4 RNs/techs, budget for 4 x 1.15 = 4.6 FTE.
Avoid overworking staff with very long hours, which leads to fatigue and burn-out. The average RN salary will be variable according to location (e.g., $35-40/hour, plus 26% benefits).
Other staffing costs include 2 RNs at all times for the holding area and o/p reception area, and support staff for the lab. The latter should be at least one person for scheduling, transcription and assistance with stocking equipment, who may be shared by EP lab personnel and other support staff.
Equipment Costs
The average costs of all items will depend on the purchasing power of the hospital, and the types and mix of devices implanted. For example, the average ICD price may be $23,000 for a mix of CRT and single/dual devices in a hospital with good purchasing contracts, and $5300 for pacemakers. Many individual device systems may cost more if separate components are purchased individually and not as a system, or if new technology is not included in the initial purchasing agreement.
Hint! Include a “new technology clause” in purchasing agreements to allow implantation of state-of-the art technology as it becomes available, avoiding an add-on premium which may reduce the advantage of the initially negotiated savings. In addition, some hospitals may include a clause within the purchasing agreement to encourage offering of clinical research protocols to centers signing contracts. Contract durations typically vary from 1-3 years. If a >1 year contract is elected, the “new technology” clause would be considered essential.
Most centers have the most experience with device company negotiations (i.e., Biotronik, Boston Scientific, Medtronic and St. Jude). Depending on the center’s purchasing power, all companies may be included in the contract, with an anticipated percentage or number of devices from each company. Some centers may elect 1-2 companies to further reduce pricing. However, referring physician preference must be taken into account. If one or more manufacturers are excluded from the contract agreement, the very high price paid for single or occasional devices from an excluded manufacturer may dramatically reduce the overall savings.
Want to learn more?
See a sample budget.
Learn about projecting revenues.
Test your planning assumptions using a start up lab template.
