Effect of Transcatheter Aortic Valve Replacement Program Ratings on Case Selection.

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Medical Economics

Background:

• Public reporting of transcatheter aortic valve replacement (TAVR) outcomes by U.S. News & World Report (USNWR) commenced in August 2020.
• The influence of these hospital ratings on TAVR case selection has remained unexamined.

Purpose of the Study:

• To assess the impact of USNWR hospital TAVR ratings on the risk profile of patients undergoing the procedure.
• Investigate changes in patient selection following the introduction of USNWR TAVR ratings.

Main Methods:

• A difference-in-difference analysis was employed, comparing Medicare fee-for-service beneficiaries undergoing TAVR.
• Patient risk profiles (Elixhauser comorbidity score) were analyzed before and after the USNWR ratings release.
• Hospitals were categorized into lower-rated (average or below) and high-performing groups.

Main Results:

• After ratings release, lower-rated hospitals saw a significantly greater reduction in patient Elixhauser comorbidity scores compared to higher-rated hospitals (difference-in-difference = -0.48, P < 0.0001).
• A substantial decline in high-risk TAVR cases (Elixhauser score > 20) was observed across all hospitals, with lower-rated facilities showing a more pronounced decrease (IRR = 0.56, P < 0.0001).
• The study included 138,147 TAVR patients pre-ratings and 50,650 post-ratings across 618 hospitals.

Conclusions:

• Since 2020, a significant decrease in high-risk patients receiving TAVR has occurred nationwide.
• This trend is primarily driven by hospitals that received lower USNWR TAVR ratings, suggesting potential risk aversion in case selection.
• Further research is needed to understand the drivers of this shift and develop strategies to ensure appropriate patient access to TAVR.