As of now, readmissions after PCIs are not publicly reported in the U.S. Still, a pilot program may serve as a model for the future as physicians and payers focus more on the value of cardiology care.
Researchers Jason H. Wasfy, MD, MPhil, and Robert W. Yeh, MD, MSc, of Harvard Medical School evaluated the program recently in Circulation: Cardiovascular Quality Outcomes.
Starting in 2013, the Centers for Medicare and Medicaid Services and the National Cardiovascular Data Registry began publically reporting risk-adjusted 30-day readmission rates after PCI. The program was limited to U.S. hospitals that submitted data to the National Cardiovascular Data Registry’s CathPCI registry and was stopped in December 2013.
Wasfy and Yeh noted that the Physician Consortium for Quality Improvement and National Committee for Quality Assurance recognized the importance of 30-day death and readmission measures after PCI. However, those organizations as well as the American College of Cardiology have not included PCI readmission as a publically reported measure.
Heart disease costs account for nearly a third of Medicare spending and a fifth of total healthcare spending and are expected to triple by 2030. To that end, the government’s hospital readmission reduction program focuses on acute MI and congestive heart failure, although it does not include PCI without acute MI.
An explanation for not tracking PCI readmissions is that they do not relate closely to procedural complications. Wasfy and Yeh cited a study from the Geisinger Medical Center that found only 11.9 percent of readmissions following PCI were related to procedural complications. They added that research has also shown hospital readmissions were associated with mental illness, poor social support, poverty and other population characteristics rather than just a hospital or physician’s performance.
“Despite all this, focusing on PCI readmission still holds substantial promise for improving value in cardiology care,” they wrote. “Just because readmissions are not related to procedural complications does not mean that they are not preventable. The tools to prevent these readmissions, however, must focus more on patient education, access to outpatient care, and attention to medication reconciliation rather than improvements in procedural technique.”
Wasfy and Yeh recommended that future research focuses on understanding the causes of disparities in readmission rates. Even before then, though, tracking PCI readmissions may be a good idea.
“Many provider organizations are currently incentivized to minimize overall health spending through accountable care organization contracts,” they wrote. “Cardiology care is a major focus of accountable care organizations. Because PCI readmissions are costly, potentially preventable, and can reduce availability of hospital beds, provider organizations may improve quality and performance in accountable care organization contracts by reducing PCI readmissions.”