PCI-capable hospitals accrue 'modestly' higher costs

Thirty-day costs for acute MI patients on Medicare were $627 higher for admissions to PCI vs. non-PCI-capable hospitals in a recent study. This higher price tag, while relatively modest, still needs to be justified, the researchers wrote.

Gal Ben-Josef, MD, of Boston Children’s Hospital and the Boston Medical Center, and colleagues reviewed Medicare data from 2008 to stimulate discussion on differences in cost of care. Acute MI admissions identified were cross-referenced against Medicare pay tables to determine what costs were accrued during the 30-day period.

Medicare paid a mean of $20,340 and $19,713 for PCI hospitals and non-PCI hospitals, respectively, per patient when analyzed at a 30-day risk standardized payment perspective. While hospitals without PCI capability appeared to incur less expense, the researchers asked whether this difference is really an advantage to patients.

The research team found that while patients at PCI hospitals had higher rates of many procedures during index admissions, they also had lower transfer rates and lower revascularization rates within 30 days than patients who originally presented at non-PCI hospitals.

PCI rates were 39.2 percent and 13.2 percent for PCI and non-PCI hospitals, respectively. CABG was also performed twice as often on patients who presented to PCI hospitals. However, short-term revascularization rates were lower in patients from PCI hospitals, 0.15 percent compared to 0.27 percent at non-PCI institutions. Patients who went to PCI hospitals were transferred in only 2.2 percent of cases, as opposed to 25.5 percent seen from non-PCI hospitals. This translated to higher mean unadjusted index hospital payments, but lower payments in the post-acute care setting for PCI hospital patients.

The questions that remained for Ben-Josef et al surrounded whether or not the extra cost provided extra value, as the difference in price is significant per year when patient costs are aggregated. They were unable, from the data provided, to clarify some questions on mortality, readmission and overall patient improvement.

Long-term costs and patient outcomes should be part of future research on this topic, Ben-Josef et al advised.

The study was published online Nov. 11 in Circulation: Cardiovascular Quality and Outcomes.