Ruben L Osnabrugge1, Alan M Speir2, Stuart J Head1, Philip G Jones3, Gorav Ailawadi4, Clifford E Fonner5, Edwin Fonner6, A Pieter Kappetein1, Jeffrey B Rich7. 1. Erasmus University Medical Center, Rotterdam, The Netherlands. 2. Inova Heart and Vascular Institute, Fairfax, Va. 3. Saint Luke's Mid America Heart Institute, Kansas City, Mo. 4. University of Virginia Health System, Charlottesville, Va. 5. ARMUS Corporation, San Mateo, Calif; Virginia Cardiac Surgery Quality Initiative, Falls Church, Va. 6. Virginia Cardiac Surgery Quality Initiative, Falls Church, Va. 7. Sentara Heart Hospital, Norfolk, Va. Electronic address: jeffrich2014@cox.net.
Abstract
OBJECTIVE: Pay-for-performance measures, part of the Affordable Care Act, aim to reduce health care costs by linking value with Medicare payments, but until now the concept of value has not been applied to specific procedures. We sought to define value in coronary artery bypass grafting (CABG) and provide a framework to identify high-value centers. METHODS: In a multiinstitutional statewide database, clinical patient-level data from 42,839 patients undergoing CABG were matched with cost data. Hierarchical models adjusting for relevant preoperative patient characteristics and comorbidities were used to estimate center-specific risk-adjusted costs and risk-adjusted postoperative length of stay. Variation in value across centers was assessed by the correlation between risk-adjusted measures of quality (mortality, morbidity/mortality) and resource use (costs and length of stay). RESULTS: There were no significant correlations between risk-adjusted costs and risk-adjusted mortality (r = 0.20, P = .45) or morbidity/mortality (r = 0.15, P = .57) across centers. Risk-adjusted costs and length of stay were not significantly associated (r = 0.23, P = .37) because of cost accounting differences across centers. This may explain the lack of correlation between risk-adjusted quality and risk-adjusted cost measures. When risk-adjusted length of stay and morbidity/mortality were used for the framework, there was a strong positive correlation (r = 0.67, P = .003), indicating that higher risk-adjusted quality is associated with shorter risk-adjusted length of stay. CONCLUSIONS: Risk-adjusted length of stay and risk-adjusted combined morbidity/mortality are important outcome measures for assessing value in cardiac surgery. The proposed framework can be used to define value in CABG and identify high-value centers, thereby providing information for quality improvement and pay-for-performance initiatives.
OBJECTIVE: Pay-for-performance measures, part of the Affordable Care Act, aim to reduce health care costs by linking value with Medicare payments, but until now the concept of value has not been applied to specific procedures. We sought to define value in coronary artery bypass grafting (CABG) and provide a framework to identify high-value centers. METHODS: In a multiinstitutional statewide database, clinical patient-level data from 42,839 patients undergoing CABG were matched with cost data. Hierarchical models adjusting for relevant preoperative patient characteristics and comorbidities were used to estimate center-specific risk-adjusted costs and risk-adjusted postoperative length of stay. Variation in value across centers was assessed by the correlation between risk-adjusted measures of quality (mortality, morbidity/mortality) and resource use (costs and length of stay). RESULTS: There were no significant correlations between risk-adjusted costs and risk-adjusted mortality (r = 0.20, P = .45) or morbidity/mortality (r = 0.15, P = .57) across centers. Risk-adjusted costs and length of stay were not significantly associated (r = 0.23, P = .37) because of cost accounting differences across centers. This may explain the lack of correlation between risk-adjusted quality and risk-adjusted cost measures. When risk-adjusted length of stay and morbidity/mortality were used for the framework, there was a strong positive correlation (r = 0.67, P = .003), indicating that higher risk-adjusted quality is associated with shorter risk-adjusted length of stay. CONCLUSIONS: Risk-adjusted length of stay and risk-adjusted combined morbidity/mortality are important outcome measures for assessing value in cardiac surgery. The proposed framework can be used to define value in CABG and identify high-value centers, thereby providing information for quality improvement and pay-for-performance initiatives.
Authors: Robert B Hawkins; J Hunter Mehaffey; Eric J Charles; John A Kern; D Scott Lim; Nicholas R Teman; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2018-03-09 Impact factor: 4.330
Authors: John C Moscona; Jason D Stencel; Gregory Milligan; Christopher Salmon; Rohit Maini; Paul Katigbak; Qusai Saleh; Ryan Nelson; Sudesh Srivastav; Owen Mogabgab; Rohan Samson; Thierry Le Jemtel Journal: Ann Transl Med Date: 2018-08
Authors: Alexander A Brescia; Joceline V Vu; Chang He; Jun Li; Steven D Harrington; Michael P Thompson; Edward C Norton; Scott E Regenbogen; John D Syrjamaki; Richard L Prager; Donald S Likosky Journal: Circ Cardiovasc Qual Outcomes Date: 2020-11-12