Hospitalization After PCI and Value | Journal Scan

Study Questions:

What is the association between facility-level hospitalization rates after percutaneous coronary intervention (PCI) and cost of care?

Methods:

The investigators studied 32,080 patients who received PCI at any one of 62 Veterans Administration (VA) hospitals from 2008 to 2011. They identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. The authors used Bayesian hospital profiling methods to estimate standardized mortality, hospitalization, and cost ratios and rates, and to identify facility outliers for 30-day risk-standardized mortality, hospitalization, and cost.

Results:

Compared with the risk-standardized average, two (3.2%) hospitals had a lower than expected hospitalization rate and two (3.2%) hospitals had a higher than expected hospitalization rate. The investigators observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 (27.4%) hospitals had lower than expected costs and 14 (22.6%) hospitals had higher than expected costs. At the facility level, the index PCI accounted for 83.1% of total cost (range 60.3-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range 2.0-12.7%) of 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ = 0.16; 95% confidence interval, -0.09 to 0.39; p value = 0.21).

Conclusions:

The authors concluded that hospitalizations in the 30 days after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates.

Perspective:

This study reports that costs attributable to hospitalization after PCI represented <6% of total cost, and variations in facility-level cost were not clearly correlated with hospitalization rates. In contrast, costs of the index PCI accounted for >80% of total cost, and significant variation in costs of the index hospitalization were observed. These findings may have important implications for measuring the value of PCI care delivery, and may influence strategies of health care reimbursement to incentivize improvements in value-based health care. Overall, it appears that there is an opportunity to reduce variation in the total cost of PCI without compromising patient outcomes and achieve high-value care delivery.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Health Care Costs, Hospital Costs, Hospitalization, Hospitals, Mortality, Outcome Assessment (Health Care), Percutaneous Coronary Intervention, Risk, United States Department of Veterans Affairs


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