Accountable care altering the role of technology in the marketplace
In the past, cardiovascular administrators were able to principally concern themselves with the acute care episode and realize significant success. Under fee-for-service, the cost and length of an inpatient stay has been of primary concern. However, market incentives have begun to shift to encourage care across the continuum, as evidenced by the Readmissions Reduction Program and payment innovations such as bundled payment and shared savings. As accountable care shifts risk for cost and quality to providers, cardiovascular administrators will be required to provide longitudinal care and manage total cost.
Refocusing technology investments on cost effectiveness, long-term outcomes
As reported in the Daily Briefing, patients who received elective percutaneous coronary interventions (PCI) at hospitals without on-site cardiac surgery fared as well as those who underwent the same procedure at hospitals with surgery backup,according to a study presented at the American Heart Association’s (AHA) annual meeting.
Over 1 million PCIs are performed annually in the UnitedStates, and the majority of these procedures are not emergent. Currently, the AHA and the American College of Cardiology recommend that PCI be performed only at hospitals offering coronary artery bypass grafting (CABG), resulting in limited patient access to PCI in some communities.
The Cardiovascular Patient Outcomes Research Team Elective (C-PORT E) trial, the first to evaluate surgical backup for elective PCI cases, evaluated 4,500 patients who underwent PCI at hospitals with an available cardiovascular surgeon, and an additional 14,000 patients who underwent PCI without on-site surgical backup. The 60 institutions performing PCI without on-site surgery had to perform at least 200 PCI procedures annually and undergo a special PCI training program, while participating interventionalists were required to perform a minimum of 75 PCIs each year.
On-site surgery not necessary to perform elective PCI
Coronary CT angiography (CCTA) – a non-invasive anatomical imaging study most commonly used to identify possible stenoses in the coronary artery tree – continues to gain greater acceptance as a viable modality to diagnose or rule-out the presence of coronary artery disease (CAD). When compared to well-established techniques such as stress testing and myocardial perfusion imaging, CCTA often demonstrates comparable, if not superior, diagnostic performance. As such, proponents argue CCTA – when used for appropriate patients and indications – can obviate the need for myocardial perfusion imaging and additional testing. In addition, CCTA may result in more efficient care by safely discharging patients with a negative test result who may otherwise undergo cardiac catheterization.
Despite its utility, few studies have examined the impact of CCTA on downstream testing and procedures, and subsequently, health care spending, when compared to standard approaches. This week, two new studies helped to shed light on the impact of CCTA, though the data result in more questions than answers regarding CCTA’s ability to reduce downstream utilization and health care costs.
Does CCTA increase costs and downstream interventions?