Hospitals currently cannot recover increased costs of treating Medicare patients experiencing certain complications associated with revascularization procedures. Pending reimbursement changes to no longer pay for "avoidable complications" will increase the financial risk to hospitals. These are among the findings of a new study conducted and funded by Cardiac Data Solutions, Inc. (CDS), in conjunction with leading physician researchers, and presented at the American Heart Association Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference.
The study focused on the average hospital costs and reimbursement values for more than 505,000 Medicare beneficiaries undergoing either Coronary Artery Bypass Graft Surgery (CABG) or Percutaneous Coronary Intervention (PCI) between October 1, 2005 and September 30, 2006. Researchers compared results for patients who did and did not experience selected complications.
The study found:
-- Hospitals essentially break even on revascularization procedures where Medicare beneficiaries do not experience in-hospital mortality or specific post-operative complications.
-- Even with higher DRG payments and Medicare reimbursements (between 15 and 73%), hospitals on average still lose money when a Medicare beneficiary undergoing a revascularization procedure experiences one of the complications studied.
"This study contradicts a widely held belief that hospitals get paid more and have their costs covered when patients experience certain complications," says April Simon, RN, MSN, one of the researchers and CDS founder/president. The study concluded that proposed changes by the Centers for Medicare and Medicaid Services to eliminate incremental payments for selected "avoidable" complications could put even greater financial pressure on hospitals.
Simon adds, "The costs of complications should provide the incentive for hospitals to invest in true quality improvement efforts, focusing less on reporting and more on making changes necessary to reduce complications."
Lead researcher for the study was Aaron Kugelmass, MD, director of Cardiac Catheterization at Henry Ford Hospital. Other researchers included: Phillip Brown, MD, cardiovascular surgeon (retired) and past chairman, Department of Surgery, Centennial Medical Center; David J. Cohen, MD, interventional cardiologist and director, Cardiovascular Research, Mid America Heart Institute, St. Luke's Hospital; Matthew R. Reynolds, MD, electrophysiologist and director, Economics and Quality of Life Core Lab, Harvard Clinical Research Institute; and Steven D. Culler, Ph.D., associate professor, Rollins School of Public Health, Emory University.
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