Same-Day Discharge for Elective PCI Patients Cuts Hospital Costs

Cheryl Clark, for HealthLeaders Media , October 5, 2011

Even though PCI is safer than ever, most hospitals still keep most low-risk patients overnight. And while Rao or Brindis emphasized that their findings should be confirmed by other studies, perhaps a Medicare demonstration project, the potential savings to hospitals and use of resources is enormous.

Brindis, an interventional cardiologist at Kaiser Permanente, Oakland in Northern California, calculated a "back-of-the-envelope" estimate of the saving: Of 700,000 patients who undergo a PCIs each year, one-third are elective, and about 20% of those might be sent home in the afternoon or early evening on the day of their procedure, rather than waiting in observation that night.

"That could potentially free up 35,000 beds for other patients," he suggested. "And if the average cost of a bed day is $1,000 to $2,000, well, that would be significant."

Medicare reimburses hospitals for PCI patients who stay overnight, but not 24 hours, at the same rate as someone who stays only 12 or 10 hours.

Rao said that economies will be more important to hospitals after the implementation of accountable care organizations and bundled payments.

"If we ever get to the point with bundled payments, which it looks like it's probably going to happen, the faster you get the patient out, the more margin there is for the hospital. But they shouldn't do it unless it's safe," Rao said.

Rao added, "Ours is not a call to widely implement same-day discharge. But what centers need to do is examine their own practices. If they've got a patient they're keeping overnight, and they realize that their rates of events within that 23-hour period are low, probably zero – and they're incredibly low in our study – they probably need to look at these elective patients and send them home the same day."

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2 comments on "Same-Day Discharge for Elective PCI Patients Cuts Hospital Costs"

Dr. Simon Lo (10/7/2011 at 10:21 AM)
Very good news. I have been doing day-case PCI since 2002. Finally there is good evidence to support my procedure

Kenneth R Rubin MD MA MHCM FACEP (10/6/2011 at 2:39 PM)
Interestingly, this study reaches the same conclusion as do many previous such studies, that among a [INVALID]ED group of low-risk patients undergoing elective PCI, sameday discharge is safe. In this study, 84% of all patients needing PCI were eliminated from the study cohort on clinical grounds, while only 1.25% of patients were actually discharged on the same day as their PCI. Both Milliman Care Guidelines and the healthcare payer community have conveniently and dangerously generalized 1.25% to mean all patients needing PCI. The vast majority of studies in the evidence-based medical literature, exclude significant percentages of patients from the outpatient PCI study cohorts for safety reasons. Yet, Milliman Care Guidelines and the payer community claim that outpatient PCI is the standard of care for EVERY patient. What we are witnessing is the nearly universal misinterpretation of the evidence-based medical literature, for financial gain of the payer community, at the expense of hospitals, who provide the necessary inpatient level of care for most patients. This study, by Rao et al, in its context statement, says: "Patients undergoing elective percutaneous coronary intervention (PCI) are generally observed overnight in the hospital." Most hospitals do keep patients overnight, not observing, but providing an inpatient level of care, including room-and-board costs, for the sake of patient safety. Hospitals should be correctly reimbursed for the inpatient level of care, the only prudent and safe manner in which to manage elective PCI in 88.5% of cases. The evidence-based medical literature, such as the present study by Rao et al[INVALID]despite being twisted, perverted, and misinterpreted by the payer community[INVALID]clearly shows outpatient PCI to be UNSAFE for the vast majority of patients. Do not allow the payers to make a travesty of the evidence-based medical literature. Kenneth R. Rubin, MD, MA, MHCM, FACEP Physician Advisor, St. Francis Hospital-The Heart Center




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