Reducing costs and improving outcomes of percutaneous coronary interventions.
OBJECTIVE
To describe cost reduction and quality improvement efforts in our percutaneous coronary intervention (PCI) program and how risk adjustment was used to assess the effects of these changes.


METHODS
Single center registry analysis.


METHODS
Data were collected on 2158 PCIs performed between July 1, 1994, and June 30, 1997. Of these, 1126 PCIs reflected care provided after implementation of competitive bidding for catheterization lab supplies, and efforts to reduce the use of postprocedure heparin and to implement early arterial sheaths removal (postbidding period). Hospital costs were estimated using a microcost accounting method. In-hospital mortality rates during the 2 time periods were compared using standardized mortality ratio estimated with a previously validated risk adjustment model for in-hospital mortality.


RESULTS
Compared with the prebidding period, the postbidding period was characterized by a significantly higher utilization of new technology (coronary stents and atherectomy devices 46% vs 25%; abciximab 19.1% vs 3.7, P<.01), and an overall increase in case complexity. Despite these changes, the average and median postbidding cost per case was dollars 1223 and dollars 1444 lower, respectively, than in the prebidding period. After adjustment for comorbidities, procedure variables, complications, and length of hospital stay, multivariate regression modeling identified the postbidding period as an independent predictor of lower hospital costs (P<.001) with an estimated adjusted cost savings of dollars 460. These cost savings were associated with trends toward a lower observed mortality rate, a higher predicted mortality rate, and a significantly lower standardized mortality ratio (SMR .71; 95% CI 0.48-0.9; P<.05).


CONCLUSIONS
Despite an increase in case complexity and utilization of new technology, cost reductions can be achieved through competitive bidding for supplies and modifications of periprocedure care. Risk adjustment appears to be a valid tool for assessing the effectiveness of these efforts independently from changes in case mix.
Division of Cardiology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, 48109-0119, USA. moscucci@umich.edu
Mauro
M
Moscucci
David W
DW
Muller
Charles M
CM
Watts
Vinita
V
Bahl
Eric R
ER
Bates
Steven W
SW
Werns
Eva
E
Kline-Rogers
Dean
D
Karavite
Kim A
KA
Eagle
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000592:standards*; D003164:Competitive Bidding; D003327:Coronary Disease / Q000628:therapy*; D003363:Cost Control; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics / Q000592:standards; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011446:Prospective Studies; D020379:Risk Adjustment; D016896:Treatment Outcome