title: Future of the PCI Readmission Metric.
abstract: Between 2013 and 2014, the Centers for Medicare and Medicaid Services and the National Cardiovascular Data Registry publically reported risk-adjusted 30-day readmission rates after percutaneous coronary intervention (PCI) as a pilot project. A key strength of this public reporting effort included risk adjustment with clinical rather than administrative data. Furthermore, because readmission after PCI is common, expensive, and preventable, this metric has substantial potential to improve quality and value in American cardiology care. Despite this, concerns about the metric exist. For example, few PCI readmissions are caused by procedural complications, limiting the extent to which improved procedural technique can reduce readmissions. Also, similar to other readmission measures, PCI readmission is associated with socioeconomic status and race. Accordingly, the metric may unfairly penalize hospitals that care for underserved patients. Perhaps in the context of these limitations, Centers for Medicare and Medicaid Services has not yet included PCI readmission among metrics that determine Medicare financial penalties. Nevertheless, provider organizations may still wish to focus on this metric to improve value for cardiology patients. PCI readmission is associated with low-risk chest discomfort and patient anxiety. Therefore, patient education, improved triage mechanisms, and improved care coordination offer opportunities to minimize PCI readmissions. Because PCI readmission is common and costly, reducing PCI readmission offers provider organizations a compelling target to improve the quality of care, and also performance in contracts involve shared financial risk.
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W.) and The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.). jwasfy@mgh.harvard.edu.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W.) and The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.).
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000592:standards; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005544:Forecasting; D017048:Health Care Costs; D006801:Humans; D006278:Medicare / Q000592:standards; D010359:Patient Readmission / Q000191:economics / Q000592:standards* / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics / Q000592:standards* / Q000639:trends; D017064:Process Assessment, Health Care / Q000191:economics / Q000592:standards* / Q000639:trends; D058996:Quality Improvement / Q000191:economics / Q000592:standards* / Q000639:trends; D019984:Quality Indicators, Health Care / Q000191:economics / Q000592:standards* / Q000639:trends; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Medicare; coronary heart disease; percutaneous coronary intervention; quality assessment, healthcare; quality improvement; risk adjustment