title: Hospitalization costs for acute myocardial infarction patients treated with percutaneous coronary intervention in the United States are substantially higher than Medicare payments.
abstract: BACKGROUND
  Acute coronary syndromes account for half of all deaths secondary to cardiovascular disease and represent a significant economic burden in the United States. Therefore, assessing hospitalization costs relative to Medicare reimbursement for these patients is important in understanding the impact of these patients on hospitals. We hypothesized that hospitalization costs for acute myocardial infarction patients treated with percutaneous coronary intervention (PCI) were higher than their associated Medicare payments.
  
  
  METHODS
  Using the Nationwide Inpatient Sample, we evaluated hospitalization costs for patients treated with PCI from 2001 through 2009 by multiplying hospital charges by the group average cost-to-charge ratio for each patient's hospitalization. Primary end points examined were total hospital costs and trends over time, which were correlated with clinical outcomes and insurance payments. Costs were inflation adjusted with 2009 as the reference year.
  
  
  RESULTS
  Median hospitalization costs of PCI increased from $15 889 (interquartile range [IQR] = $12 057-$21 204) in 2001 to $19 349 (IQR = $14 660-$26 282) in 2009. From 2004 to 2009, inflation-adjusted costs for PCI decreased at a rate of 0.3% per year. In 2009, a total of 265,531 patients received PCI for acute myocardial infarction. Of these, 143 654 were <65 years old, and 121 876 were ≥65 years old. Average 2009 Medicare payments ranged from $9303 to $17 500 depending on the Medicare Severity-Diagnosis Related Groups (MS-DRG) billed, leaving hospitals at a loss of anywhere from $4493 to $7940 per patient when comparing costs and reimbursements across all included MS-DRG codes.
  
  
  CONCLUSIONS
  Hospitalization costs for patients treated with PCI have been stabilizing over the last few years; however, there still remains a significant disparity between Medicare reimbursements and hospitalization costs, which has potential implications on patient outcomes, quality of care, and hospital sustainability.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Majed
authors.initials: M
authors.lastname: Afana
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.forename: Harry
authors.initials: H
authors.lastname: Cloft
authors.forename: Samer
authors.initials: S
authors.lastname: Salka
mesh_terms: D054058:Acute Coronary Syndrome / Q000191:economics* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059019:Clinical Coding / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000191:economics*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult