As reported in the Daily Briefing, pay-for-performance models will exaggerate regional disparities in care and further penalize hospitals serving poor communities, according to a study published in the journal PLoS Medicine finding that hospital quality variations are "substantially associated" with a region's economic and workforce resources.
For the study, researchers from New York University Medical School analyzed performance for two common cardiac conditions—myocardial infarction (MI) and heart failure (HF)—at 2,705 hospitals between 2004 and 2007 and regional variation across five "dimensions of location": poverty, unemployment, provider shortage, non-high school graduates in the workforce and college graduates in the workforce.
Pay-for-Performance Widens Gap Between 'Have,' 'Have-Not' Hospitals
The Society for Cardiovascular Angiography and Interventions (SCAI) recently announced the formation of the Accreditation for Cardiovascular Excellence organization (ACE), which plans to begin accrediting facilities performing carotid artery stenting (CAS) in July.
The launch of ACE's CAS accreditation program is part of SCAI's ongoing efforts to encourage CMS to adopt a more formalized approach to ensuring providers meet facility requirements for performing CAS procedures. Programs interested in becoming accredited will need to submit data to ACE and host a site visit. Accreditation will last for a two-year period, after which a review of the facility will be required for continued recognition.
'Smart' Implantable Devices May Revolutionize Cardiac Care
Results from the highly anticipated Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) were published online, ahead of print in the New England Journal of Medicine. The published data indicate there is no difference in long-term outcomes between endarterectomy (CEA) and carotid artery stenting (CAS).
In the CREST trial 2,502 patients with either asymptomatic or symptomatic carotid artery stenosis were randomized to CEA or CAS. After the procedure, patients received neurological exams, optimal medical therapy, and risk factor management. The primary endpoint was the combined incidence rate of stroke, myocardial infarction or death. Four year follow-up results showed that the combined incidence rate was 7.2% and 6.8% for the CAS and CEA cohorts, respectively. This difference was not statistically significant. While long-term outcomes were equivalent, short-term outcomes between the groups varied. During the perioperative period, patients undergoing CAS had higher risk of stroke, whereas those in the CEA group had higher risk of myocardial infarction.
CREST Trial Indicates Equivalent Outcomes for CAS, CEA