TCT: Patients covered by private payors are less likely to undergo PCI

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A higher payment tier was inversely associated with the incidence of PCIs during diagnostic coronary angiography, according to research presented at the annual Transcatheter Cardiovascular Therapeutics (TCT) conference in Washington, D.C., last week.

The appropriate utilization of resources in cardiology had been scrutinized based on the existing system of fee-for-services, according to Fernando Boccalandro, MD, an interventional cardiologist at Odessa Heart Institute in Odessa, Texas. Therefore, he and his colleagues sought to identify the characteristics of patients undergoing coronary angiography according to their source of funding and to assess the impact of different reimbursement-tiers in the frequency of PCI procedures.

The researchers designed a retrospective cohort study of patients undergoing coronary angiography in Medical Center Hospital in Odessa, Texas, from 2004 to 2009. The patients were stratified according to their funding: Group 1 (High Tier): commercial insurances; Group 2 (Mid Tier): state-funded agencies; and Group 3 (Low Tier): self-funded patients.

They collected demographic, procedural data and the percentage of PCI per coronary angiographies, and compared with an analysis of variance (ANOVA) for continuous variables and a chi-square test for categorical variables. They also used multivariate analysis adjusted for baseline variables to assess the impact of the source of reimbursement resulting in a PCI.

Out of a total of 9,340 patients, 33 percent were Group 1, 57 percent were Group 2 and 10 percent were Group 3. The participants had a mean age of 63 years, and 54 percent were males.

Boccalandro also reported that Group 2 had more women, older patients, higher incidence of diabetes, prior revascularization, chronic obstructive pulmonary disease, prior stroke, peripheral vascular disease and heart failure.

Group 3 had more active smokers, the highest percentage of PCIs (Group 1, 26 percent; Group 2, 32 percent; Group 3, 38 percent) and the highest in-hospital mortality (Group 1, 1 percent; Group 2, 2 percent; Group 3, 6 percent).

Boccalandro said that the multivariate analysis adjusted for baseline demographic variables showed an increased odds of undergoing PCI in older patients (odds ratio (OR): 2.3); diabetics (OR: 2.1); smokers (OR: 3.3); patients with prior CABG (OR: 1.7); patients with prior PCI (OR: 2.2); and self-funded patients (OR: 2.2).

“Patients undergoing coronary angiography funded by state-agencies comprise a group of older patients with higher number of co-morbidites,” he and his colleagues found. “Self-funded patients have a higher frequency of tobacco abuse, with significantly higher number of PCIs and in-hospital mortality.”