Alexander A Brescia1, John D Syrjamaki2, Scott E Regenbogen3, Gaetano Paone4, Andrew L Pruitt5, Francis L Shannon6, Theodore J Boeve7, Himanshu J Patel8, Michael P Thompson9, Patricia F Theurer10, James M Dupree2, Karen M Kim1, Richard L Prager8, Donald S Likosky11. 1. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. 2. Michigan Value Collaborative, Ann Arbor, Michigan; Department of Urology, University of Michigan, Ann Arbor, Michigan. 3. Michigan Value Collaborative, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan. 4. Henry Ford Hospital Division of Cardiac Surgery, Detroit, Michigan. 5. Michigan Heart and Vascular Institute, St. Joseph Mercy Hospital, Ann Arbor, Michigan. 6. Division of Cardiovascular Surgery, Beaumont Health, Royal Oak, Michigan. 7. Section of Cardiac Surgery, Spectrum Health, Grand Rapids, Michigan. 8. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan. 9. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Value Collaborative, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan. 10. Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan. 11. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan. Electronic address: likosky@med.umich.edu.
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has increased in volume as an alternative to surgical aortic valve replacement (SAVR). Comparisons of total episode expenditures, although largely ignored thus far, will be key to the value proposition for payers. METHODS: We evaluated 6,359 Blue Cross Blue Shield of Michigan and Medicare fee-for-service beneficiaries undergoing TAVR (17 hospitals, n = 1,655) or SAVR (33 hospitals, n = 4,704) in Michigan between 2012 and 2016. Payments through 90 post-discharge days between TAVR and SAVR were price-standardized and risk-adjusted. Centers were divided into terciles of procedural volume separately for TAVR and SAVR, and payments were compared between lowest and highest terciles. RESULTS: Payments (± SD) were higher for TAVR than SAVR ($69,388 ± $22,259 versus $66,683 ± $27,377, p < 0.001), while mean hospital length of stay was shorter for TAVR (6.2 ± 5.6 versus 10.2 + 7.5 days, p < 0.001). Index hospitalization payments were $4,374 higher for TAVR (p < 0.001), whereas readmission and post-acute care payments were $1,150 (p = 0.001) and $739 (p = 0.004) lower, respectively, and professional payments were similar. For SAVR, high-volume centers had lower episode payments (difference: 5.0%, $3,255; p = 0.01) and shorter length of stay (10.0 ± 7.5 versus 11.1 ± 7.9 days, p = 0.002) than low volume centers. In contrast, we found no volume-payment relationship among TAVR centers. CONCLUSIONS: Episode payments were higher for TAVR, despite shorter length of stay. Although not a driver for TAVR, center SAVR volume was inversely associated with payments. These data will be increasingly important to address value-based reimbursement in valve replacement surgery.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has increased in volume as an alternative to surgical aortic valve replacement (SAVR). Comparisons of total episode expenditures, although largely ignored thus far, will be key to the value proposition for payers. METHODS: We evaluated 6,359 Blue Cross Blue Shield of Michigan and Medicare fee-for-service beneficiaries undergoing TAVR (17 hospitals, n = 1,655) or SAVR (33 hospitals, n = 4,704) in Michigan between 2012 and 2016. Payments through 90 post-discharge days between TAVR and SAVR were price-standardized and risk-adjusted. Centers were divided into terciles of procedural volume separately for TAVR and SAVR, and payments were compared between lowest and highest terciles. RESULTS: Payments (± SD) were higher for TAVR than SAVR ($69,388 ± $22,259 versus $66,683 ± $27,377, p < 0.001), while mean hospital length of stay was shorter for TAVR (6.2 ± 5.6 versus 10.2 + 7.5 days, p < 0.001). Index hospitalization payments were $4,374 higher for TAVR (p < 0.001), whereas readmission and post-acute care payments were $1,150 (p = 0.001) and $739 (p = 0.004) lower, respectively, and professional payments were similar. For SAVR, high-volume centers had lower episode payments (difference: 5.0%, $3,255; p = 0.01) and shorter length of stay (10.0 ± 7.5 versus 11.1 ± 7.9 days, p = 0.002) than low volume centers. In contrast, we found no volume-payment relationship among TAVR centers. CONCLUSIONS: Episode payments were higher for TAVR, despite shorter length of stay. Although not a driver for TAVR, center SAVR volume was inversely associated with payments. These data will be increasingly important to address value-based reimbursement in valve replacement surgery.
Authors: Parth K Modi; Devraj A Sukul; Mary Oerline; Michael P Thompson; Brahmajee K Nallamothu; Chad Ellimoottil; Vahakn B Shahinian; Brent K Hollenbeck Journal: Circ Cardiovasc Qual Outcomes Date: 2019-12-13
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
Authors: Vinayak Kumar; Gurpreet S Sandhu; Charles M Harper; Henry H Ting; Charanjit S Rihal Journal: J Am Heart Assoc Date: 2020-04-17 Impact factor: 5.501