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Trends in Coronary Revascularization Procedures Among Medicare Beneficiaries Between 2008 and 2012 | Journal Scan
Study Questions:
What are the trends in the volume and outcomes of coronary revascularization procedures performed on Medicare beneficiaries between 2008 and 2012?
Methods:
This retrospective study identifies all Medicare beneficiaries undergoing a coronary revascularization procedure: coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) performed in either the nonadmission or inpatient setting. International Classification of Diseases (ICD)-9-CM procedure codes (inpatient setting) and CPT and APC codes (nonadmission) were used to identify revascularizations.
Results:
The study population consisted of 2,768,007 records. This study found that the rapid growth in nonadmission PCIs performed on Medicare beneficiaries (60,405-106,495) had been more than offset by the decrease in PCI admissions (363,384-295,434) during the study period. There also were over 18,000 fewer CABG admissions in 2012 than in 2008. This study found lower observed mortality rates (3.7%-3.2%) among Medicare beneficiaries undergoing any CABG surgery, and higher observed mortality rates (1.7%-1.9%) for Medicare beneficiaries undergoing any PCI encounter. This study also found a growth in the number of facilities performing revascularization procedures during the study period: 268 (20.2%) more sites were performing nonadmission PCIs; 136 (8.2%) more sites were performing inpatient PCI; and 19 (1.6%) more sites were performing CABG surgery.
Conclusions:
The authors concluded that the total number of revascularization procedures performed on Medicare beneficiaries peaked in 2010, and declined by over 4% per year in 2011 and 2012.
Perspective:
This study reports that the total number of PCIs among Medicare beneficiaries has decreased since 2010, and the number of PCIs only has declined by over 15,000 procedures (-3.7%) per year. Despite the underlying changes in the type of revascularizations, the overall observed mortality rate for all revascularizations in the Medicare program remained stable per year during the study period. Furthermore, lower mortality rates for all Medicare beneficiaries undergoing CABG surgery were seen in 2012 compared to 2008, both during the inpatient admission and from admission to 90 days post-discharge. Finally, the US delivery system already has the capacity to handle any expected increase in the demand for revascularization procedures from the ‘baby boom’ generation reaching Medicare age, based on recommended annual revascularization volume levels.
Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Inpatients, International Classification of Diseases, Medicare, Patient Discharge, Percutaneous Coronary Intervention, Population Growth, Retrospective Studies, United States
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