Trends in Coronary Revascularization Procedures Among Medicare Beneficiaries Between 2008 and 2012
Background—This study reports on the trends in the volume and outcomes of coronary revascularization procedures performed on Medicare Beneficiaries between 2008 and 2012.
Methods and Results—This retrospective study identifies all Medicare beneficiaries undergoing a coronary revascularization procedure: coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) performed in either the non-admission or inpatient setting. ICD-9-CM procedure codes (inpatient setting) and CPT and APC codes (non-admission) were used to identify revascularizations. The study population consists of 2,768,007 records. This study finds that the rapid growth in non-admission PCIs performed on Medicare beneficiaries (60,405 to 106,495) has been more than offset by the decrease in PCI admissions (363,384 to 295,434) during the study period. There also were over 18,000 fewer CABG admissions in 2012 than in 2008. This study finds lower observed mortality rates (3.7% to 3.2%) among Medicare beneficiary undergoing any CABG surgery and higher observed mortality rates (1.7% to 1.9%) for Medicare beneficiaries undergoing any PCI encounter. This study also finds a growth in the number of facilities performing revascularization procedures during the study period: 268 (20.2%) more sites were performing non-admission PCIs; 136 (8.2%) more sites performing inpatient PCI; and 19 (1.6%) more sites performing CABG surgery.
Conclusions—The total number of revascularization procedures performed on Medicare beneficiaries peaked in 2010 and has declined by over 4% per year in 2011 and 2012. Observed mortality rates among all Medicare beneficiaries undergoing any coronary revascularization remained between 2.1% and 2.2% annually during the study period.
- Received July 28, 2014.
- Revision received October 14, 2014.
- Accepted November 13, 2014.