Future of the PCI Readmission Metric

Abstract

Abstract-Between 2013 and 2014, the Centers for Medicare and Medicaid Services and the National Cardiovascular DataRegistry publically reported risk-adjusted 30-day readmission rates after percutaneous coronary intervention (PCI) as a pilot project. A key strength of this public reporting effort included risk adjustment with clinical rather than administrative data. Furthermore, because readmission after PCI is common, expensive, and preventable, this metric has substantial potential to improve quality and value in American cardiology care. Despite this, concerns about the metric exist. For example, few PCI readmissions are caused by procedural complications, limiting the extent to which improved procedural technique can reduce readmissions. Also, similar to other readmission measures, PCI readmission is associated with socioeconomic status and race. Accordingly, the metric may unfairly penalize hospitals that care for underserved patients. Perhaps in the context of these limitations, Centers for Medicare and Medicaid Services has not yet included PCI readmission among metrics that determine Medicare financial penalties. Nevertheless, provider organizations may still wish to focus on this metric to improve value for cardiology patients. PCI readmission is associated with low-risk chest discomfort and patient anxiety. Therefore, patient education, improved triage mechanisms, and improved care coordination offer opportunities to minimize PCI readmissions. Because PCI readmission is common and costly, reducing PCI readmission offers provider organizations a compelling target to improve the quality of care, and also performance in contracts involve shared financial risk. (Circ Cardiovasc Qual Outcomes. 2016;9:186-189.

Clinical Interventions to Reduce Preventable Hospital Readmission After Percutaneous Coronary Intervention

“…2 Provider organizations have a variety of external and internal incentives to reduce hospital readmissions after PCI, including improving patient satisfaction and safety, improving provider performance in contracts that involve incentives for saved costs, and increasing hospital inpatient bed capacity. 3 Furthermore, because a substantial proportion of PCI patients have acute myocardial infarction as an indication for PCI, provider organizations have the potential to reduce financial penalties for acute myocardial infarction readmissions under the Hospital Readmission Reduction Program by reducing PCI readmissions. 1,4 Unlike acute myocardial infarction, PCI patients are easy to identify during the index episode of care, whereas acute myocardial infarction patients are identified retroactively using billing codes.…”

Etiologies, trends, and predictors of readmission in ST‐elevation myocardial infarction patients undergoing multivessel percutaneous coronary intervention

“…Hospital readmissions after PCI are relatively common and have caused significant financial burden on the economy of the United States . Since 2012, readmissions within 30 days after index hospitalization for acute myocardial infarction (AMI) have been included in the hospital readmission reduction program (HRRP) administered by the U.S. Centers for Medicare and Medicaid Services .…”

Should We Care About Short-Term Readmissions After Percutaneous Coronary Intervention?

“…While readmissions after PCI were not initially considered for measurement by the HRRP, the recognition that PCI was one of 7 procedures accounting for a third of overall readmission costs with substantial variation between hospitals (1) led CMS in 2013 to initiate voluntary reporting of risk standardized readmission rates for NCDR CathPCI registry participating hospitals as part of a pilot program (10). While a hospital’s readmission rates were determined from Medicare fee-for-service claims, patient demographics and clinical variables were obtained by linkage to the CathPCI registry, a process that enabled more refined risk-adjustment but precluded extension of the program to hospitals not participating in the registry (10,11).…”

“…While a hospital’s readmission rates were determined from Medicare fee-for-service claims, patient demographics and clinical variables were obtained by linkage to the CathPCI registry, a process that enabled more refined risk-adjustment but precluded extension of the program to hospitals not participating in the registry (10,11). Perhaps related to the inability to comprehensively implement this program nationally as well as evidence that readmissions after PCI appeared to be mostly unrelated to procedural quality (12–14), the pilot reporting program ended in December 2013, and the PCI readmission metric has not been adopted by the HRRP at this time (11).…”