The Heart Rhythm Society provides resources and information in a variety of formats to assist you in developing your career and improve practice management in the area of arrhythmia care and services. View the variety of business related topics, including running an EP lab and starting a private practice.
Designing an EP Lab
When setting up an EP lab, plans for space should include areas for patient preparation and recovery, as well as the space required for EP laboratory procedure.
Consider the following space requirements when designing an electrophysiology lab:
Outpatient Admission / Patient Preparation
Patients should be prepared for the procedure in a room where blood work, ECGs, a history and physical examination, and patient teaching can be performed. With plans for setting up this outpatient area, a 24-hour unit should be considered, as many procedures (including simple catheter ablation procedures) may subsequently be classified as “o/p” 24-hour observation procedures by many payers.
- RNs needed (to dispense medication, draw blood, perform assessment)
- Blood draws for additional “PATs”
- IV access
- Pre-EP assessment
- Additional patient teaching
EP Laboratory and Procedure Room
- Space for the lab itself
- Control room (room for observation/teaching)
- X-ray equipment and stereotaxis (additional space needs)
- Monitoring equipment
- Diagnostic equipment
- Tilt table area and procedure room for cardioversions, ICD checks, IV drug administration (e.g., epinephrine challenge, ibutilide)
Recovery / Holding Area
This area can be utilized for patient preparation (e.g., connecting electrodes, defibrillation patches, shaving) prior to transport to the lab, meeting the EP laboratory personnel and immediate post-procedure care (e.g., pulling sheaths, further BP and O2 monitoring following IV conscious sedation).
- RNs needed
- Telemetry
- ECG machine
- Crash cart
- Equipment for sheath pulling
Additional Space Needs
Depending on the situation, additional requirements may include:
- Reception
- Waiting area
- Space for patients to change clothes
- Staff room
- Area for dictation or space to review cases post-procedure (fellows/attendings)
- Conference room for staff education and regularly scheduled meetings
Setting up a Solo Practice
The Month-by-Month Checklists provided here will assist any EP considering opening a private practice.
Starting a medical practice is an exciting career move for a new or established EP. If you are considering a solo EP practice, you’ll be faced with the myriad details of any start-up business, as opposed to joining a cardiology group or EP practice where the infrastructure is likely be in place. But the advantages of being a solo EP practitioner are significant: you can practice what you like and the way you like. And you are free to work with all referring physicians, including those who might feel threatened if you were part of a larger multispecialty group.
Start up scenarios
The most common start-up scenario is for those who are leaving a faculty position or practice group to set up a solo practice. Frequently, the incentive to fly solo often comes from a hospital looking to establish or expand an EP program and is therefore recruiting EPs to its staff. This is the best-case scenario, since it usually indicates a solid patient base and often comes with significant start-up help or guarantees.
The process of setting up a private practice will take a minimum of 6 months, but more typically 9-12 months, especially if you are working. Delegate as much as possible to an accountant and a medical administrative office, unless you have plenty of time on your hands, are very well organized and enjoy paperwork. Ask colleagues in town for referrals to these types of services.
Determining an EP Lab Budget
When setting up a new EP lab, or administering an existing one, two kinds of budgets must be considered: capital and annual/operational. The average costs of all items will depend on the purchasing power of the hospital, and the number, types and mix of devices implanted.
Disclaimer: Manufacturers' names included in this document are intended to be illustrative and do not constitute an endorsement by the Society.
Budgeting for an EP Lab
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.
Capital Budget (Start up)
Capital Budget (Start up)
Annual (Operating) Budget
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., $40-45/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.
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.