Amit N Vora1, Dadi Dai2, Hitinder Gurm2, Amit P Amin2, John C Messenger2, Ehtisham Mahmud2, Laura Mauri2, Tracy Y Wang2, Matthew T Roe2, Jeptha Curtis2, Manesh R Patel2, Harold L Dauerman2, Eric D Peterson2, Sunil V Rao2. 1. From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.). a.vora@duke.edu. 2. From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
Abstract
BACKGROUND: Because of recent changes in criteria for coverage for inpatient hospital stays, most nonacute percutaneous coronary intervention (PCI) procedures are reimbursed on an outpatient basis regardless of underlying patient risk. Downstream effects of these changes on the risk profile of patients undergoing outpatient PCI have not been evaluated. METHODS AND RESULTS: Using the American College of Cardiology National Cardiovascular Data Registry's CathPCI Registry, we assessed temporal trends in risk profiles and rates of hospital admission among 999 279 patients undergoing PCI qualifying for outpatient reimbursement. We estimated mortality and bleeding risk using validated models from the registry. From 2009 to 2014, the proportion of outpatients not admitted to a hospital after PCI increased from 32.8% to 66.3% (P<0.001). Patients who were admitted after PCI were older, had greater comorbidities, and experienced more post-PCI complications (all P<0.001). Among those not admitted, the proportion of patients at high risk for predicted mortality increased significantly from 17.0% to 19.8% during the study period (P<0.001). In contrast, 16.7% of patients admitted after PCI were at low risk for mortality. CONCLUSIONS: Among patients undergoing PCI procedures that qualify for outpatient reimbursement, there has been a temporal decrease in postprocedure hospital admission. Concomitantly, the proportion of these outpatients at high risk for mortality has significantly increased over time. These data suggest that current reimbursement classification could be improved by incorporating patient risk to appropriately match the necessary resources to the needed level of care.
BACKGROUND: Because of recent changes in criteria for coverage for inpatient hospital stays, most nonacute percutaneous coronary intervention (PCI) procedures are reimbursed on an outpatient basis regardless of underlying patient risk. Downstream effects of these changes on the risk profile of patients undergoing outpatient PCI have not been evaluated. METHODS AND RESULTS: Using the American College of Cardiology National Cardiovascular Data Registry's CathPCI Registry, we assessed temporal trends in risk profiles and rates of hospital admission among 999 279 patients undergoing PCI qualifying for outpatient reimbursement. We estimated mortality and bleeding risk using validated models from the registry. From 2009 to 2014, the proportion of outpatients not admitted to a hospital after PCI increased from 32.8% to 66.3% (P<0.001). Patients who were admitted after PCI were older, had greater comorbidities, and experienced more post-PCI complications (all P<0.001). Among those not admitted, the proportion of patients at high risk for predicted mortality increased significantly from 17.0% to 19.8% during the study period (P<0.001). In contrast, 16.7% of patients admitted after PCI were at low risk for mortality. CONCLUSIONS: Among patients undergoing PCI procedures that qualify for outpatient reimbursement, there has been a temporal decrease in postprocedure hospital admission. Concomitantly, the proportion of these outpatients at high risk for mortality has significantly increased over time. These data suggest that current reimbursement classification could be improved by incorporating patient risk to appropriately match the necessary resources to the needed level of care.
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Authors: Mark Kheifets; Shelly Abigail Vons; Tamir Bental; Hana Vaknin-Assa; Gabriel Greenberg; Abed Samara; Pablo Codner; Guy Wittberg; Yeela Talmor Barkan; Leor Perl; Ran Kornowski; Amos Levi Journal: Front Cardiovasc Med Date: 2022-06-24