Hospitals struggle to provide care for elderly patients based on Medicare payments. Amid concerns of inadequate reimbursement, we sought to evaluate the hospitalization costs for recipients of CEA and CAS placement, identify variables associated with increased costs, and compare these costs with Medicare reimbursements.
All CEA and CAS procedures were extracted from the 2001-2008 NIS. Average CMS reimbursement rates for CEA and CAS were obtained from www.CMS.gov. Annual trends in hospital costs were analyzed by Sen slope analysis. Associations between LOS and hospital costs with respect to sex, age, discharge status, complication type, and comorbidity were analyzed by using the Wilcoxon rank sum test. Least-squares regression models were used to predict which variables had the greatest impact on LOS and hospital costs.
The 2001-2008 NIS contained 181,200 CEA and 12,485 CAS procedures. Age and sex were not predictive of costs for either procedure. Among favorable outcomes, CAS was associated with significantly higher costs compared with CEA (P < .0001). Average Medicare payments were $1,318 less than costs for CEA and $3,241 less than costs for CAS among favorable outcomes. Greater payment-to-cost disparities were noted for both CEA and CAS in patients who had unfavorable outcomes.
The 2008 Medicare hospitalization payments were substantially less than median hospital costs for both CAS and CEA. Efforts to decrease hospitalization costs and/or increase payments will be necessary to make these carotid revascularization procedures economically viable for hospitals in the long term.
[Show abstract][Hide abstract] ABSTRACT: In recent years, many important discoveries have been made to challenge current policy, guidelines, and practice regarding how best to prevent stroke associated with atherosclerotic stenosis of the origin of the internal carotid artery. TheUnited States Center forMedicare andMedicaid Services (CMS), for instance, is calling for expert advice as to whether its current policies should be modified. Using a thorough review of literature, 41 leading academic stroke-prevention clinicians from the United States and other countries, have united to advise CMS not to extend current reimbursement indications for carotid angioplasty/stenting (CAS) to patients with asymptomatic carotid stenosis or to patients with symptomatic carotid stenosis considered to be at "low or standard risk from carotid endarterectomy (CEA)." It was concluded that such expansion of reimbursement indications would have disastrous health and economic consequences for the United States and any other country that may follow such inappropriate action. This was an international effort because the experts to best advise CMS are relatively few and scattered around the world. In addition, US health policy, practice, and research have tended to have strong influences on other countries.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 03/2012; 43(3):247-51. DOI:10.1016/j.ejvs.2011.12.006 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Population distribution estimates by age and race/ethnicity from the U.S. Census Bureau for the years 2010 and 2050 were combined with estimates of stroke incidence from population-based surveillance studies to forecast the distribution of incident stroke cases for the years 2010 and 2050. Over these 40 years, the number of incident strokes will more than double, with the majority of the increase among the elderly (age 75+) and minority groups (particularly Hispanics). These increases are likely to present major logistical, scientific, and ethnical issues in the near future.
Annals of the New York Academy of Sciences 09/2012; 1268(1):14-20. DOI:10.1111/j.1749-6632.2012.06665.x · 4.38 Impact Factor
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 09/2012; 56(3):899. DOI:10.1016/j.jvs.2012.04.069 · 3.02 Impact Factor
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