The additional hospital costs generated in the management of complications of pacemaker and defibrillator implantations

Abstract

The rapid approach of capitated reimbursement mandates that providers examine their practice patterns associated with all surgical procedures. Documentation of (1) the complications associated with these procedures and (2) the additional hospital costs associated with the management of these complications is critical for comprehensive fiscal accountability. This study analyzed (1) the feasibility of obtaining accurate hospital cost data specific for complications and (2) the outcome in terms of fully loaded hospital costs generated in the management of the most common surgical complications associated with pacemaker and nonthoracotomy implantable defibrillator therapies. Between July 1989 and September 1994, a total of 1031 pacemaker and 105 implantable defibrillator procedures were performed by a cardiac surgeon in a tertiary-level teaching hospital setting. The additional fully loaded hospital costs were determined by (1) correlating clinical data from the complete medical record with complete hospital charge data for the admission(s) related to the complication, (2) carving out complication-related charges based on the clinical data, (3) converting complication-related charges to fully loaded costs based on conversion factors in effect at the time of service, and (4) correlating cost with hospital net reimbursement and payor source. The feasibility study determined that accurate and reliable cost data specific to complications can be obtained, although the process was cumbersome and difficult. The outcomes study determined that mean fully loaded complication costs were $4345 +/- $1540 for pacemaker lead revision and $4879 +/- $3167 for implantable defibrillator lead dislodgement, $24,459 +/- $14,585 for pacemaker infection, and $13,736 +/- $12,505 for defibrillator generator system malfunction. The one infected defibrillator cost $57,213 to treat. Costs exceeded reimbursement for almost all Medicare patients with complications in this study, suggesting that similar shortfalls would occur under a capitation scheme. This information is critical to a complete understanding of the financial impact of interventional procedures in a capitated reimbursement environment.

Risk Factors Related to Infections of Implanted Pacemakers and Cardioverter-Defibrillators

“…The course of untreated infections is dismal, and their management has important economic implications. 2 The estimated rate of infection after implantation of permanent endocardial leads is between 1% and 2%, although this rate varies in the literature Clinical Perspective p 1355 from 0.13% to 12.6%. [3][4][5][6][7][8][9][10][11][12][13] The files collected by the National Hospital Discharge Survey revealed that between 1996 and 2003, the rates of hospitalization for infections of implantable antiarrhythmic systems increased faster than the rates of system implantations.…”

Rates of and Factors Associated With Infection in 200 909 Medicare Implantable Cardioverter-Defibrillator Implants

“…In addition, financial costs associated with ICD infection can be significant, with an average length of stay for CIED infection from 8 to 20 days and total costs from $24 000 to $130 000. 3,4,[6][7][8] …”

Nonstaphylococcal Infections of Cardiac Implantable Electronic Devices

“…[2][3][4] The reported average cost of combined medical-surgical treatment of an infected permanent pacemaker or implantable cardioverterdefibrillator is $24 459 and $57 213, respectively. 5 …”