Clinical Data Solutions Presents Groundbreaking Research at ACC 2017

doctors and nurses at a conference table

Three new studies are the first to quantify the frequency and cost of complications associated with coronary artery bypass graft (CABG) surgery and the treatment of acute myocardial infarction (AMIs) across entire care episodes.

Value-based payments and the latest AMI and CABG research findings of Clinical Data Solutions (CDS) were the focal points of a dinner presentation made by HealthTrust physician advisor Aaron Kugelmass, M.D., during the American College of Cardiology’s 2017 annual meeting in Washington, D.C. While BPCI, CJR and commercial bundled payment programs were among the predominant models in 2016, this year brings the introduction of ones the Centers for Medicare & Medicaid (CMS) is mandating for beneficiaries getting bypass surgery or being treated for heart attacks or surgical hip and femur fracture. The rollout includes a first-ever cardiac rehabilitation incentive payment, designed to improve long-term care management and care coordination for AMI and CABG surgery patients.

 

As with CJR, hospitals in the targeted markets will be the financial risk-bearer under these new, 90-day “episode payment” models. The hospitalization portion of care traditionally represents the largest portion of expenditures for treatment. An analysis of Medicare Provider Analysis and Review (MedPAR) files finds 73 percent of CABG surgery costs, or an average $31,180, is attributable to the index admission (including supplies) and another 7 percent ($2,942) for readmissions. For AMI, the breakouts looks considerably different. Half of CMS spend is for the index admission and the majority of the other half is for readmissions. Under value-based payment models, identifying at-risk patients and mitigating untoward outcomes is critical, Kugelmass says.

 

HealthTrust Research

Kugelmass discussed relevant findings from recent CDS research, including two studies separately shared as posters at ACC plus an oral presentation—all taking a groundbreaking look at costs across care episodes extending 90 day post-discharge. Here’s the recap of those studies, based on MedPAR data:

 

Study: What is the Impact of Complications during the Index Hospitalization on Resource Utilization during the 90-day follow-up period Associated with CABG Surgery among Medicare Beneficiaries?

Investigators: Phillip P. Brown, M.D., Aaron D. Kugelmass, M.D., David J. Cohen, M.D., Matthew R. Reynolds, M.D., Marc R. Katz, M.D., Michael L. Schlosser, M.D., April W. Simon, MSN, and Steven D. Culler, Ph.D.)

Key takeaways:

  • Nearly a quarter (23.4 percent) of patients have at least one adverse event, for which Medicare spends an average of $10,814 more for the index admission and $15,941 across the 90-day bundle—almost one-third of it for post-acute services
  • Total Medicare spending for each type of post-acute service in the 90-day bundle was significantly higher when there was an adverse event during the index CABG hospitalization
  • Four adverse events—postoperative infection, postoperative stroke, new onset hemodialysis and postoperative acute respiratory distress syndrome—resulted in more than $10,000 in incremental spend for the bundle

 

Study: Medicare Reimbursement Associated with AMI Hospitalization and 90-day Post-Discharge

Investigators: Aaron D. Kugelmass, M.D., David J. Cohen, M.D., Matthew R. Reynolds, M.D., Marc R. Katz, M.D., Phillip P. Brown, M.D., Michael L. Schlosser, M.D., April W. Simon, MSN, and Steven D. Culler, Ph.D.

Key takeaways:

  • Less than half (42.6 percent) of patients admitted for AMI undergo PCI
  • Among AMI patients overall, 13.8 percent have at least one adverse event during their index admission
  • Average Medicare spend for patients having at least one adverse event was $8,630 higher than for those who did not experience complications, and spend was higher both for the index hospitalization and post-acute services
  • For the average AMI episode, Medicare spends $20,954
  • AMI patients receiving PCI costs Medicare $6,602 more than those without PCI, but are less likely to incur spending on any post-acute service (excepting outpatient services)
  • Seven of 24 comorbid conditions associated with higher episode costs increase Medicare spending by more than $4,000—dialysis dependent, AIDs, cardiac arrest (present on admission, or POA), cardiogenic shock (POA), heart failure, ventricular fibrillation (POA) and type 1 diabetes mellitus

 

Study: Understanding Readmissions in Medicare Beneficiaries During the 90-day Follow-up Period Following an AMI Admission

Investigators: Aaron D. Kugelmass, M.D., David J. Cohen, M.D., Matthew R. Reynolds, M.D., Marc R. Katz, M.D., Phillip P. Brown, M.D., Michael L. Schlosser, M.D., April W. Simon, MSN, and Steven D. Culler, Ph.D.

Key takeaways:

  • About 28 percent of AMI patients have at least one hospital readmission in the 90 days following their index AMI admission and, among that group, 31.2 percent underwent a PCI while 68.8 percent were treated medically
  • Among patients treated medically, the most common reasons for readmissions were heart failure, cardiac surgery, sepsis and respiratory illnesses—accounting for over 35 percent of all readmissions
  • Among patients who received a PCI, the top reasons for readmissions were heart failure, angina, respiratory illnesses and GI bleeding—accounting for over 35 percent of all readmissions
  • Four variables increased the likelihood of having a readmission by more that 30 percent—end stage renal disease (POA), not having a PCI during the index hospitalization, type I diabetes and heart failure

 

Authors: Aaron Kugelmass, M.D., FACC and April Simon, RN, MSN

Author Information

Aaron Kugelmass

Aaron Kugelmass

Aaron Kugelmass, M.D., FACC, is a board-certified interventional cardiologist. He is chief of the cardiology division and director of the Heart and Vascular Center at Baystate Medical Center in Springfield, Massachusetts. Dr. Kugelmass also serves as an advisor for both HealthTrust and Clinical Data Solutions. More Articles by This Author »