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Changes in PCI Deemed “Inappropriate” by AUC
Study Questions:
What are the trends in inappropriate percutaneous coronary intervention (PCI) in New York?
Methods:
The authors applied appropriate use criteria (AUC) to PCI procedures performed in New York in patients without acute coronary syndromes or previous coronary artery bypass graft surgery in periods before (2010 through 2011) and after (2012 through 2014) efforts were made to improve appropriateness rates.
Results:
The proportion of inappropriate PCIs for all patients dropped from 18.2% in 2010 to 10.6% in 2014, and among patients with no acute coronary syndrome/no prior coronary artery bypass graft surgery procedures rated as inappropriate, decreased from 2,956 patients in 2010 to 911 patients in 2014.
Conclusions:
There has been a substantial decline in PCI for elective indications and in inappropriate PCI in New York between 2010 and 2014.
Perspective:
There has been a steady decline in inappropriate PCI across the country (Desai NR, et al., JAMA 2015;314:2045-53), and the findings in New York mirror this trend. The New York State health department had threatened to withhold payment for PCIs classified as inappropriate and this may have served as one of the drivers of this change. While the decline in inappropriate PCI is welcome and worth celebrating, it is somewhat troubling that AUC are being used as an arbitrator of payment policy. The AUC are based mostly on expert consensus and should be used to guide, but not define treatment and payment decisions.
Keywords: Acute Coronary Syndrome, Consensus, Coronary Artery Bypass, Inappropriate Prescribing, Insurance, Health, Reimbursement, Myocardial Revascularization, Percutaneous Coronary Intervention, Elective Surgical Procedures
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