title: Cost Analysis of Physician Assistant Home Visit Program to Reduce Readmissions After Cardiac Surgery.
abstract: BACKGROUND
  A physician assistant home care (PAHC) program providing house calls was initiated to reduce hospital readmissions after adult cardiac surgery. The purpose of our study was to compare 30-day PAHC and pre-PAHC readmission rate, length of stay, and cost.
  
  
  METHODS
  Patients who underwent adult cardiac surgery in the 48 months from September 2008 through August 2012 were retrospectively reviewed using pre-PAHC patients as the control group. Readmission rate, length of stay, and health care cost, as measured by hospital billing, were compared between groups matched with propensity score.
  
  
  RESULTS
  Of the 1,185 patients who were discharged directly home, 155 (13%) were readmitted. Total readmissions for the control group (n = 648) was 101 patients (16%) compared with the PAHC group (n = 537) total readmissions of 54 (10%), a 38% reduction in the rate of readmission (p = 0.0049). Propensity score matched groups showed a rate reduction of 41% with 17% (62 of 363) for the control compared with 10% (37 of 363) for the PAHC group (p = 0.0061). The average hospital bill per readmission was $39,100 for the control group and $56,600 for the PAHC group (p = 0.0547). The cost of providing home visits was $25,300 for 363 propensity score matched patients.
  
  
  CONCLUSIONS
  The PAHC program reduced the 30-day readmission rate by 41% for propensity score matched patients. Analysis demonstrated a savings of $977,500 at a cost of $25,300 over 2 years, or $39 in health care saved, in terms of hospital billing, for every $1 spent. Therefore, a home visit by a cardiac surgical physician assistant is a cost-effective strategy to reduce readmissions after cardiac surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York. Electronic address: jnabagiez@northwell.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Nabagiez
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York.
authors.forename: Masood A
authors.initials: MA
authors.lastname: Shariff
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York.
authors.forename: William J
authors.initials: WJ
authors.lastname: Molloy
authors.affiliation: Biostatistics Unit, Feinstein Institute for Medical Research at Staten Island University Hospital, Northwell Health, Staten Island, New York.
authors.forename: Seleshi
authors.initials: S
authors.lastname: Demissie
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: McGinn
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D003365:Costs and Cost Analysis; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D010823:Physician Assistants; D057216:Propensity Score; D012189:Retrospective Studies