Abstract 3238: Financial Impact to Hospitals of Changing Medicare Payment Policy for Avoidable Complications Associated with Cardiovascular Admissions
Objective: CMS has proposed 17 avoidable complications (AVC) that will no longer result in incremental hospital reimbursement. This analysis identifies AVC rates among 5 types of cardiovascular procedures and calculates the financial impact to hospitals of this payment policy.
Methods: This retrospective study examined MedPar Files from 2006 to identify all hospital admissions where a Medicare Beneficiary (MB) underwent CABG, cardiac valve surgery, PCI, ICD implant, or PPM implant. The study population consists of 823,097 admissions. ICD-9-CM codes reported by CMS were used to identify MB experiencing AVC. Two measures of financial impact were calculated:
difference in hospital length of stay between MB who did and did not experience the AVC; and
the potential financial loss (average reimbursement of those who didn’t experience an AVC - average cost of those MB who experienced the AVC).
Findings: The table reports the number of complications and financial impact for AVC where more than 0.2% of MB undergoing a cardiovascular procedure experienced the complication. This table⇓ indicates that the incidence of AVC is below 2.5% for all complications except septicemia among MB undergoing CABG and Cardiac Valve Surgery. Average length-of-stay (LOS) increased among MB experiencing AVC by more than 10 days for all but 9 of the 35 possible procedure/complication combinations reported. The financial impact of an AVC varied from a low of -$1,373 per event (iatrogenic pneumothorax among valve admissions) to a high of -$58,215 per event (ventilator-associated pneumonia among valve admissions).
Conclusions: The relatively low rates for most of CMS’s proposed AVC will limit the impact of this payment policy change on Medicare expenditures for cardiovascular procedures. However, the financial impact on individual hospitals may be significant if they have multiple patients experience AVCs.