Costs Associated With Access Site and Same-Day Discharge Among Medicare Beneficiaries Undergoing Percutaneous Coronary Intervention: An Evaluation of the Current Percutaneous Coronary Intervention Care Pathways in the United States

Amit P. Amin, Mark Patterson, John A. House, Helmut Giersiefen, John A. Spertus, Dmitri V. Baklanov, Adnan K. Chhatriwalla, David M. Safley, David J. Cohen, Sunil V. Rao, Steven P. Marso

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objectives The aim of this study was to examine the independent impact of various care pathways, including those involving transradial intervention (TRI) and same-day discharge (SDD) after elective percutaneous coronary intervention (PCI), on hospital costs. Background PCI is associated with costs of $10 billion annually. Alternative payment models for PCI are being implemented, but few data exist on strategies to reduce costs. Various PCI care pathways, including TRI and SDD, exist, but their association with costs and outcomes is unknown. Methods In total, 279,987 PCI patients eligible for SDD in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims files were analyzed. Hospital costs in 2014 U.S. dollars were estimated using cost-to-charge ratios. Propensity scores for TRI and SDD, with propensity adjustment via inverse probability weighting, was performed. Results Of the 279,987 PCI procedures, TRI was used in 9.0% (13.5% of which were SDD), and SDD was used in 5.3% of cases (23.1% of which were TRI). TRI (vs. transfemoral intervention) was associated with lower adjusted costs of $916 (95% confidence interval [CI]: $778 to $1,035), as was SDD ($3,502; 95% CI: $3,486 to $3,902). The adjusted cost associated with TRI and SDD was $13,389 (95% CI: $13,161 to $13,607), while the cost associated with transfemoral intervention and non-same-day discharge was $17,076 (95% CI: $16,999 to $17,147), a difference of $3,689 (95% CI: $3,486 to $3,902; p < 0.0001). Shifting current practice from transfemoral intervention non-same-day discharge to TRI SDD by 30% could potentially save a hospital performing 1,000 PCIs each year $1 million and the country $300 million annually. Conclusions Among Medicare beneficiaries, TRI with SDD was independently associated with fewer complications and lower in-hospital costs. These findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs.

Original languageEnglish (US)
Pages (from-to)342-351
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume10
Issue number4
DOIs
StatePublished - Feb 27 2017

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Percutaneous Coronary Intervention
Costs and Cost Analysis
Confidence Intervals
Hospital Costs
Medicare
Registries
Propensity Score

Keywords

  • bleeding
  • costs
  • health economics
  • outcomes
  • percutaneous coronary intervention
  • radial PCI
  • same-day discharge
  • transradial PCI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Costs Associated With Access Site and Same-Day Discharge Among Medicare Beneficiaries Undergoing Percutaneous Coronary Intervention : An Evaluation of the Current Percutaneous Coronary Intervention Care Pathways in the United States. / Amin, Amit P.; Patterson, Mark; House, John A.; Giersiefen, Helmut; Spertus, John A.; Baklanov, Dmitri V.; Chhatriwalla, Adnan K.; Safley, David M.; Cohen, David J.; Rao, Sunil V.; Marso, Steven P.

In: JACC: Cardiovascular Interventions, Vol. 10, No. 4, 27.02.2017, p. 342-351.

Research output: Contribution to journalArticle

Amin, Amit P. ; Patterson, Mark ; House, John A. ; Giersiefen, Helmut ; Spertus, John A. ; Baklanov, Dmitri V. ; Chhatriwalla, Adnan K. ; Safley, David M. ; Cohen, David J. ; Rao, Sunil V. ; Marso, Steven P. / Costs Associated With Access Site and Same-Day Discharge Among Medicare Beneficiaries Undergoing Percutaneous Coronary Intervention : An Evaluation of the Current Percutaneous Coronary Intervention Care Pathways in the United States. In: JACC: Cardiovascular Interventions. 2017 ; Vol. 10, No. 4. pp. 342-351.
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abstract = "Objectives The aim of this study was to examine the independent impact of various care pathways, including those involving transradial intervention (TRI) and same-day discharge (SDD) after elective percutaneous coronary intervention (PCI), on hospital costs. Background PCI is associated with costs of $10 billion annually. Alternative payment models for PCI are being implemented, but few data exist on strategies to reduce costs. Various PCI care pathways, including TRI and SDD, exist, but their association with costs and outcomes is unknown. Methods In total, 279,987 PCI patients eligible for SDD in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims files were analyzed. Hospital costs in 2014 U.S. dollars were estimated using cost-to-charge ratios. Propensity scores for TRI and SDD, with propensity adjustment via inverse probability weighting, was performed. Results Of the 279,987 PCI procedures, TRI was used in 9.0{\%} (13.5{\%} of which were SDD), and SDD was used in 5.3{\%} of cases (23.1{\%} of which were TRI). TRI (vs. transfemoral intervention) was associated with lower adjusted costs of $916 (95{\%} confidence interval [CI]: $778 to $1,035), as was SDD ($3,502; 95{\%} CI: $3,486 to $3,902). The adjusted cost associated with TRI and SDD was $13,389 (95{\%} CI: $13,161 to $13,607), while the cost associated with transfemoral intervention and non-same-day discharge was $17,076 (95{\%} CI: $16,999 to $17,147), a difference of $3,689 (95{\%} CI: $3,486 to $3,902; p < 0.0001). Shifting current practice from transfemoral intervention non-same-day discharge to TRI SDD by 30{\%} could potentially save a hospital performing 1,000 PCIs each year $1 million and the country $300 million annually. Conclusions Among Medicare beneficiaries, TRI with SDD was independently associated with fewer complications and lower in-hospital costs. These findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs.",
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T1 - Costs Associated With Access Site and Same-Day Discharge Among Medicare Beneficiaries Undergoing Percutaneous Coronary Intervention

T2 - An Evaluation of the Current Percutaneous Coronary Intervention Care Pathways in the United States

AU - Amin, Amit P.

AU - Patterson, Mark

AU - House, John A.

AU - Giersiefen, Helmut

AU - Spertus, John A.

AU - Baklanov, Dmitri V.

AU - Chhatriwalla, Adnan K.

AU - Safley, David M.

AU - Cohen, David J.

AU - Rao, Sunil V.

AU - Marso, Steven P.

PY - 2017/2/27

Y1 - 2017/2/27

N2 - Objectives The aim of this study was to examine the independent impact of various care pathways, including those involving transradial intervention (TRI) and same-day discharge (SDD) after elective percutaneous coronary intervention (PCI), on hospital costs. Background PCI is associated with costs of $10 billion annually. Alternative payment models for PCI are being implemented, but few data exist on strategies to reduce costs. Various PCI care pathways, including TRI and SDD, exist, but their association with costs and outcomes is unknown. Methods In total, 279,987 PCI patients eligible for SDD in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims files were analyzed. Hospital costs in 2014 U.S. dollars were estimated using cost-to-charge ratios. Propensity scores for TRI and SDD, with propensity adjustment via inverse probability weighting, was performed. Results Of the 279,987 PCI procedures, TRI was used in 9.0% (13.5% of which were SDD), and SDD was used in 5.3% of cases (23.1% of which were TRI). TRI (vs. transfemoral intervention) was associated with lower adjusted costs of $916 (95% confidence interval [CI]: $778 to $1,035), as was SDD ($3,502; 95% CI: $3,486 to $3,902). The adjusted cost associated with TRI and SDD was $13,389 (95% CI: $13,161 to $13,607), while the cost associated with transfemoral intervention and non-same-day discharge was $17,076 (95% CI: $16,999 to $17,147), a difference of $3,689 (95% CI: $3,486 to $3,902; p < 0.0001). Shifting current practice from transfemoral intervention non-same-day discharge to TRI SDD by 30% could potentially save a hospital performing 1,000 PCIs each year $1 million and the country $300 million annually. Conclusions Among Medicare beneficiaries, TRI with SDD was independently associated with fewer complications and lower in-hospital costs. These findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs.

AB - Objectives The aim of this study was to examine the independent impact of various care pathways, including those involving transradial intervention (TRI) and same-day discharge (SDD) after elective percutaneous coronary intervention (PCI), on hospital costs. Background PCI is associated with costs of $10 billion annually. Alternative payment models for PCI are being implemented, but few data exist on strategies to reduce costs. Various PCI care pathways, including TRI and SDD, exist, but their association with costs and outcomes is unknown. Methods In total, 279,987 PCI patients eligible for SDD in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims files were analyzed. Hospital costs in 2014 U.S. dollars were estimated using cost-to-charge ratios. Propensity scores for TRI and SDD, with propensity adjustment via inverse probability weighting, was performed. Results Of the 279,987 PCI procedures, TRI was used in 9.0% (13.5% of which were SDD), and SDD was used in 5.3% of cases (23.1% of which were TRI). TRI (vs. transfemoral intervention) was associated with lower adjusted costs of $916 (95% confidence interval [CI]: $778 to $1,035), as was SDD ($3,502; 95% CI: $3,486 to $3,902). The adjusted cost associated with TRI and SDD was $13,389 (95% CI: $13,161 to $13,607), while the cost associated with transfemoral intervention and non-same-day discharge was $17,076 (95% CI: $16,999 to $17,147), a difference of $3,689 (95% CI: $3,486 to $3,902; p < 0.0001). Shifting current practice from transfemoral intervention non-same-day discharge to TRI SDD by 30% could potentially save a hospital performing 1,000 PCIs each year $1 million and the country $300 million annually. Conclusions Among Medicare beneficiaries, TRI with SDD was independently associated with fewer complications and lower in-hospital costs. These findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs.

KW - bleeding

KW - costs

KW - health economics

KW - outcomes

KW - percutaneous coronary intervention

KW - radial PCI

KW - same-day discharge

KW - transradial PCI

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