A better understanding of the variations in total cost of care for PCI, when evaluated against related quality of care measures in ACC's CathPCI Registry, may help facilities improve the value of care delivery, according to an abstract presented as part of ACC's Cardiovascular Summit Virtual.

In an effort to help hospitals and health systems better understand the relationship between costs and quality for PCI, Steven M. Bradley, MD, MPH, FACC, et al., benchmarked the average total cost of care, in terms of the amounts charged and allowed for reimbursement, for elective and nonelective PCI procedures. The total cost of care was calculated based on the entire PCI episode of care, including all associated services. Cost data is not currently available in the CathPCI Registry.

The ACC partnered with FAIR Health, a convener of claims data, to identify 134 procedure codes that indicate a PCI occurrence, as well as related resource utilization codes. The study included all clinically related billing codes that occurred within the episode of care, defined as 60 days pre-procedure through 90 days post-procedure for elective PCIs and 15 days pre-procedure through 90 days post-procedure for nonelective PCIs. The researchers then reviewed claims data for adult patients with private insurance who underwent PCI between 2016 and 2019 at facilities participating in the CathPCI Registry. The researchers then stratified the total cost of care by elective vs. nonelective indications to calculate average total cost of care.

Based on preliminary results, the average amount charged for nonelective PCIs increased by 18.8% for men and 35.3% for women. For nonelective PCIs, the amount allowed for reimbursement increased by 18.6% for men and 34.3% for women. For elective PCI, the amount charged increased by 23.9% for men and 29.2% for women, while the amount allowed for reimbursement increased by 1.47% for men and 39.3% for women.

The researchers conclude that the identified variations in total cost of care, when evaluated against related quality of care registry measures, may help improve the value of cardiovascular care delivery. The results may impact clinical practice by enabling cardiovascular clinicians to understand the total cost of care, which can guide them in identifying opportunities to address cost of care while also optimizing outcomes through quality improvement efforts in the CathPCI Registry. The researchers note that the data is a first step in providing cost transparency to sites participating in the CathPCI Registry with "future efforts directed at offering granular insights on cost, quality and outcomes necessary to achieve the goal of high-value care."

The Percutaneous Coronary Intervention Cost of Care Study will be available to sites participating in the CathPCI Registry in March.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Percutaneous Coronary Intervention, Benchmarking, Episode of Care, Quality Improvement, Registries, National Cardiovascular Data Registries, Hospitals, Delivery of Health Care, Insurance, CathPCI Registry

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