Harvard researchers examine PCI readmission metric

A pilot program from the Centers for Medicare and Medicaid Services (CMS) and the National Cardiovascular Data Registry (NCDR) that evaluated and reported risk-adjusted 30-day readmission rates after PCI may serve as a model to improve the quality and value of cardiology care.

However, researchers noted that the program had some limitations, including that PCI readmissions are caused by procedural complications and associated with socioeconomic status and race.

Researchers Jason H. Wasfy, MD, MPhil and Robert W. Yeh, MD, MSc of Harvard Medical School published their commentary online in Circulation: Cardiovascular Quality Outcomes on Jan. 26.

CMS and the NCDR reported data on risk-adjusted 30-day readmissions following PCI between 2013 and 2014. Although Wasfy and Yeh said relying on risk adjustment with registry data was a strength of the program, they noted that hospitals volunteered to participate in the registry. Thus, the results may not be generalizable.

The researchers noted that preventing readmissions could improve the quality of care and reduce costs for cardiology patients. Still, since the program was stopped, the federal government has not required PCI readmissions to be publicly reported. CMS has also not included PCI readmissions among metrics that determine Medicare financial penalties.

The American College of Cardiology has not determined if PCI readmissions would become a publicly reported measure, either, according to the researchers.

“As such, the future of this metric in the United States remains unclear,” they wrote.

Further, the researchers noted that two of the first three conditions included in the government’s hospital readmission reduction program were related to cardiology: acute MI and congestive heart failure. They said that more than half of PCIs are performed in patients with an indication other than acute MI.

Limitations of the PCI readmission metrics, according to the researchers, include that the cost of PCI readmission is only 5.8 percent of the cost of total PCI episodes of care and that PCI readmission is not closely related to procedural complications.

Still, the researchers wrote that “focusing on PCI readmission still holds substantial promise for improving value in cardiology care.” To prevent readmissions, they suggested focusing on patient education, access to outpatient care and attention to medication reconciliation. They cited data that found nearly half of PCI readmissions were preventable with improved clinical care.

“Understanding the association of demographic and social factors with PCI readmission and other readmissions is essential to improving equity and reducing disparities in health outcomes,” they wrote. “Including socioeconomic status in administrative risk-adjustment models for PCI and other conditions may minimize unintended consequences. Despite these limitations, reducing PCI readmissions still offers an opportunity to improve value in cardiology care nationally.”