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."