17 Amin aimradial20170922 Cost of TRA
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17 Amin aimradial20170922 Cost of TRA
- 1. Costs of Transradial PCI Amit Amin MD MS, Washington University School of Medicine, St. Louis, MO
- 2. • I have no financial conflicts of interest related to this presentation Disclosures
- 3. Exorbitant Costs of Coronary Disease Care in the United States $10 Billion $6.4 Billion 0 2 4 6 8 10 12 PCI Cost CAD hospitalization US$(Billions) Annual Costs Centers for Medicare and Medicaid, CAD white paper, version date 5/20/16
- 4. Payment Method Payer Provider Provider Minimal Risk Provider High Performance Risk FinancialRisk How quickly will this transition occur? CMS is Shifting Risk From Payer to Provider
- 5. Hospitals are struggling -20% -15% -10% -5% 0% 5% 10% 15% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Hospital Medicare Margins IP OP Overall Source: MedPAC report March 2015
- 6. Hospital Costs vs. CMS Payments for PCI $17,604 $16,431 $14,900 $17,361 $10,438 $11,936 $10,428 $15,070 $0 $5,000 $10,000 $15,000 $20,000 Boone CNE MoBap BJH Cost Payment
- 7. Large Variation in Costs of PCI across US Hospitals $0 $10,000 $20,000 $30,000 $40,000 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100103106109112115118121124127130133136139142145148151154157160163166169172175178181184187190193196199202205208211214217220223226229232235238241244247250253256 MeanhospitalPCIcosts($) Hospitals ranked in ascending order of their PCI costs Variation in Hospital Costs of PCI 32% of the variation in PCI costs was explained by ‘hospitals’ alone, despite extensive adjustment of patient level factors Amin AP et al. AHA QCOR conference 2015
- 8. The Changing Face of PCI….
- 9. Risk and Complexity of PCI Patients is Increasing • Comorbidities are on the rise Amin AP et al. Submitted to JACC Intv
- 11. Very Challenging to Provide “High Value Care” when Risk is High
- 12. Improving Value For PCI Patients
- 13. MATRIX Trial Fatal Events: All-Cause, Cardiac, non-CV mortality, type of stent thrombosis % RR:0.72 (0.53-0.99) P=0.045 RR: 0.75 (0.54-1.04) P=0.08 Fatal Events
- 14. Radial mega-analysis N=76 studies (15 rand; 61 obs); 761,919 patients Bertrand OF, et. al. AHJ 2012
- 15. Methods Amin AP et al. JACC Cardiovasc Interv. 2013 Aug;6(8):827-34. Detailed costs from 5 US Hospitals
- 16. Adjusted Costs of Radial PCI: From 5 US Hospitals $14,954 $15,784 $14,000 $14,500 $15,000 $15,500 $16,000 Radial Femoral P < 0.001 Δ $ 830 favoring radial PCI Amin AP et al. JACC Cardiovasc Interv. 2013 Aug;6(8):827-34.
- 17. Current Hospital Costs of PCI: the PCI Care Pathway Amin AP et al. JACC Intv. 2017
- 18. Δ $ 3,600 favoring radial SDD PCI Current Hospital Costs of PCI: the PCI Care Pathway Amin AP et al. JACC Intv. 2017
- 19. Cost savings to a hospital performing 1,000 elective PCI procedures annually, when converting from the current pathway of TFI NSDD to TRI SDD Amin AP et al. JACC Intv. 2017
- 20. BJH Same Day Discharge Program
- 21. Same Day Discharge (~80%) has reduced LOS and Cost Amin AP et al. Submitted to Circ QCO
- 22. 68% 63% 26% 36% 67% 20% 28% 18% 0% 20% 40% 60% 80% Type C lesion Long lesion > 20 mm SVG graft Diabetes CHF CVD PVD COPD Prevalence of Comorbidities and Lesion Complexity among Same Day Discharges
- 23. Patient Satisfaction is High with SDD 19% 82% 12% 88% 0% 25% 50% 75% 100% Excellent Care - No Excellent Care - Yes Extremely Satisfied - No Extremely Satisfied - Yes
- 24. Lower Spend with SDD
- 26. Thank you!
- 27. Thank you!