title: Comparison of hospitalization costs and Medicare payments for carotid endarterectomy and carotid stenting in asymptomatic patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Clinician Investigator Training Program, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. mcdonald.robert@mayo.edu
authors: R J
authors: RJ
authors: McDonald
authors: D F
authors: DF
authors: Kallmes
authors: H J
authors: HJ
authors: Cloft
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016894:Endarterectomy, Carotid / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D015995:Prevalence; D015607:Stents / Q000191:economics*; D020521:Stroke / Q000191:economics* / Q000517:prevention & control* / Q000601:surgery; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology