Hospitals, patients may benefit from transradial PCIs, same-day discharges

Each year in the U.S., PCIs account for approximately $10 billion in costs, making them the most expensive cardiovascular procedure. With the federal government and private payers introducing bundled care programs and other initiatives, hospitals performing PCIs are now responsible for keeping those costs down.

A recent study suggests that hospitals could save $332 million on an annual basis simply by switching to a transradial approach to PCIs and discharging patients on the same day as they are admitted. The results were published in JACC: Cardiovascular Interventions on Feb. 20.

The researchers analyzed nearly 280,000 Medicare fee-for-service beneficiaries who underwent PCI between July 1, 2009, and Dec. 31, 2012, and were enrolled in the National Cardiovascular Data Registry CathPCI Registry.

After adjusting for several risk factors, transradial interventions cost $916 less than transfemoral interventions, while same-day discharges saved $3,502 per procedure.

A hospital that performs 1,000 elective PCI procedures each year could save $1 million if they have a 30 percent conversion from transfemoral, non-same-day discharge to transradial, same-day discharge, according to the researchers. Hospitals could also save up to $350,000 if they shift 100 cases per year to the transradial, same-day discharge approach.

Still, the projected cost savings may be easier said than done. Only 9 percent of patients received the transradial approach, 5.3 percent of patients had a same-day discharge and 1.2 percent had the transradial approach and a same-day discharge.

And yet, changing approaches may benefit hospitals and patients. The in-hospital bleeding rates were 1.4 percent in patients in the transradial group and 3 percent in patients in the transfemoral group. The rates of transfusion and other vascular complications were lower in the transradial group, as well.

The federal government could help shift the standard of care, too. The researchers noted that the Centers for Medicare and Medicaid Services (CMS) in 2013 implemented the two-midnight rule, which noted that inpatient admissions were appropriate only if physicians expect patients to stay in the hospital for at least two midnights. Thus, they mentioned that more PCI patients will be classified as outpatients. If hospitals classify PCI patients as outpatients but do not discharge them on the same day, hospitals could have an increased cost of $2,000 to $4,000 per PCI, according to the analysis.

CMS also has Bundled Payments for Care Improvement initiative, which holds hospitals accountable for lowering costs and improving the quality of care. As such, the researchers suggested that changing to a transradial, same-day discharge approach could help hospitals in this new healthcare era.

“As participation of hospitals and practices under these alternative payment models increases, providers will need to embrace these changes and identify areas of opportunity to maintain a competitive advantage,” the researchers wrote. “This study of index PCI hospitalization cost across various PCI care pathways should guide hospitals in reducing costs of index PCI care and conserve resources that could be reallocated more efficiently for downstream costs of care in the era of bundled payments.”