Trends in coronary revascularization procedures among Medicare beneficiaries between 2008 and 2012
Steven D Culler1, Aaron D Kugelmass2, Phillip P Brown2
1From the Rollins School of Public Health, Emory University, Atlanta, GA (S.D.C.); Baystate Health, Springfield, MA (A.D.K.); HealthTrust Purchasing Group, L.P., Nashville, TN (P.P.B., A.W.S.); and Lahey Hospital & Medical Center, Burlington, MA (M.R.R.). sculler@emory.edu.
Insights
Coronary revascularization procedures for Medicare beneficiaries declined after 2010, with shifts towards outpatient percutaneous coronary intervention (PCI). Overall mortality rates for these cardiac procedures remained stable.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Geriatric Cardiology
Background:
- Trends in coronary revascularization procedures among Medicare beneficiaries from 2008 to 2012 were examined.
- Focus on changes in procedure volume and patient outcomes.
Purpose of the Study:
- To analyze temporal trends in the volume and outcomes of coronary revascularization procedures.
- To compare outcomes between coronary artery bypass graft surgery and percutaneous coronary intervention (PCI).
- To assess changes in facility utilization for these procedures.
Main Methods:
- Retrospective analysis of Medicare beneficiary data (2,768,007 records) from 2008-2012.
- Identification of coronary artery bypass graft surgery and percutaneous coronary intervention (PCI) using ICD-9-CM, CPT, and APC codes.
- Inclusion of both inpatient and non-admission (outpatient) settings.
Main Results:
- A significant increase in non-admission PCI procedures was observed, while inpatient PCI volumes decreased.
- Coronary artery bypass graft surgery admissions also declined during the study period.
- Lower mortality rates were associated with coronary artery bypass graft surgery compared to PCI, though overall mortality remained stable.
- An increase in the number of facilities performing all types of revascularization procedures was noted.
Conclusions:
- The total volume of coronary revascularization procedures peaked in 2010 and subsequently declined.
- Annual mortality rates for Medicare beneficiaries undergoing revascularization remained consistent between 2.1% and 2.2%.
Background:
This study reports on the trends in the volume and outcomes of coronary revascularization procedures performed on Medicare beneficiaries between 2008 and 2012.
Methods And Results:
This retrospective study identifies all Medicare beneficiaries undergoing a coronary revascularization procedure: coronary artery bypass graft surgery or percutaneous coronary intervention (PCI) performed in either the nonadmission or inpatient setting. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes (inpatient setting) and Current Procedural Terminology and Ambulatory Payment Classification codes (nonadmission) were used to identify revascularizations. The study population consists of 2,768,007 records. This study finds that the rapid growth in nonadmission PCIs performed on Medicare beneficiaries (60,405-106,495) has been more than offset by the decrease in PCI admissions (363,384-295,434) during the study period. There also were >18,000 fewer coronary artery bypass graft admissions in 2012 than in 2008. This study finds lower observed mortality rates (3.7%-3.2%) among Medicare beneficiaries undergoing any coronary artery bypass graft surgery and higher observed mortality rates (1.7%-1.9%) for Medicare beneficiaries undergoing any PCI encounter. This study also finds a growth in the number of facilities performing revascularization procedures during the study period: 268 (20.2%) more sites were performing nonadmission PCIs; 136 (8.2%) more sites were performing inpatient PCIs; and 19 (1.6%) more sites were performing coronary artery bypass graft surgery.
Conclusions:
The total number of revascularization procedures performed on Medicare beneficiaries peaked in 2010 and declined by >4% per year in 2011 and 2012. Observed mortality rates among all Medicare beneficiaries undergoing any coronary revascularization remained between 2.1% and 2.2% annually during the study period.
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