Hospitals to lose $10K-$20K per CV procedures under Medicare program

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NEW ORLEANS—The initial financial impact of Medicare's new Value-based Purchasing initiative, which took effect Oct. 1, will be relatively small for U.S. hospitals in regard to hospital-acquired conditions (HAC) for five of the most common cardiovascular procedures, according to research presented Monday at the American Heart Association (AHA) Scientific Sessions.

Matthew R. Reynolds, MD, from Beth Israel Deaconess Medical Center and the Harvard Clinical Research Institute in Boston, presented the findings of the Financial Impact to Hospitals of Changing Medicare Payment Policy for Avoidable Complications Associated with Cardiovascular Admissions.

For most of the 11 HACs for which Medicare will no longer assign higher reimbursement rates, Reynolds reported that the average loss per case will be between $10,000 and $20,000. However, losses are projected to be higher for two of the HACs when associated with cardiac surgical procedures: mediastinitis at nearly $70,000 and pressure ulcers at more than $40,000. Pressure ulcers also had the highest incremental length of stay for all five procedures studied, adding on average 10 to nearly 18 days.

The researchers studied data on Medicare beneficiaries who underwent one of the following procedures between Oct. 1, 2005 and Sept. 30, 2006: CABG; any cardiac valve surgery; PCI; an implantable cardioverter defibrillator implant; and a permanent pacemaker implant.

The study examined differences in hospital costs and length of stay for Medicare patients who did and did not experience one of the 11 HACs, for which the Centers for Medicare & Medicaid Services (CMS) no longer assigns a higher paying diagnostic-related group when the condition is not present upon admission.

The researchers also suggested that all hospitals should pay particular attention to incidence rates for pressure ulcers, falls and mediastinitis associated with cardiovascular procedures and focus efforts as needed to improve quality in these areas.

The Atlanta-based Cardiac Data Solutions, which provides consultation services, data analysis, clinical benchmarks, management tools and research services to hospitals, physicians, payors, manufacturers and the financial community, funded the study.