Over four years, the percentage of “inappropriate” percutaneous coronary interventions (PCI) and use of PCI for elective procedures decreased significantly in New York, according to research published March 6 in the Journal of the American College of Cardiology. 

The study, led by Edward L. Hannan, PhD, FACC, et al., used New York’s Percutaneous Coronary Interventions Reporting System to gather data from 58 non-federal New York State hospitals. Researchers included all PIC patients who underwent the procedure between January 1, 2010 and December 31, 2014, and identified the patients by primary payer and year.

The results of the study found that the percent of inappropriate PCIs across all patients decreased from 18.2 percent in 2010 to 10.6 percent in 2014. The primary outcome – primary payer – did not significantly influence the reduction of inappropriateness over time (15.3 percent to 6.8 percent for Medicaid patients vs. 18.6 percent to 11.2 percent for other patients).

“These decreases were due, at least in part, to national publicity and national quality improvement efforts resulting from the publication of the [Appropriate Use Criteria] and other studies related to the appropriateness of revascularization,” the authors explain. While “it remains to be seen whether payers will begin to deny payments on the basis of inappropriateness,” the authors believe it may be unnecessary.

“Some of this change could also be improved medical treatment and studies showing that many patients with stable disease do not benefit from PCI,” adds Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org.

In an accompanying editorial, Frederick A. Masoudi, MD, MSPH, FACC, et al., explain that in 2011, ACC’s CathPCI Registry began providing participating hospitals feedback about the appropriateness of their PCI procedures. “Simultaneously, national quality improvement campaigns, such as the [ABIM Foundation’s] Choosing Wisely Initiative, identified PCI appropriateness as a key area for reducing overuse, and insurers incorporated measures of PCI appropriateness into pay-for-performance programs,” they explain.

Moving forward, they suggest coupling measurements of appropriateness and underuse, which “will require clinically detailed data for populations of patients potentially eligible for a procedure, a greater challenge than assessing procedural appropriateness.”

Keywords: Hospitals, Hospitals, State, Insurance Carriers, Medicaid, New York, Percutaneous Coronary Intervention, Quality Improvement, Registries, Reimbursement, Incentive, Angiography

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