American College of Cardiology

American College of Cardiology

Issue: June 2012
April 05, 2012
1 min read

New Medicare/Medicaid rule increases ICD patient costs, lengths of stay

Issue: June 2012
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Longer lengths of stay, increased cost per case and a greater number of procedures with anesthesiologists or additional cardiologists administering sedation have all been observed in implantable cardioverter-defibrillator implantation procedures following a policy change from the Centers for Medicare and Medicaid Services, according to  research presented at the American College of Cardiology’s 61st Scientific Sessions.

The study investigated ICD implant procedures following a new CMS requirement mandating that practitioners providing deep sleep sedation be independent from the practitioner performing the procedure. The policy change went into effect in February 2010.

Researchers reviewed 431 ICD implant cases at Indiana University Health Methodist Hospital in Indianapolis; 243 implant procedures were performed before the policy change and 188 were performed after the change.

The post-policy group showed longer lengths of stay, with a mean of 4.1 days, compared with 2.9 days in the group with procedures done before the policy change. Mean cost per case increased by $844 following the policy change. Compared with the group who underwent procedures before the policy change, the post-policy group also had significantly more cases performed under Anesthesiologist Administered Sedation (7.4% vs. 51.1%) and Additional Cardiologist-Administered Deep Sedation (0% vs. 45.7%). Prior to the policy change, 92.6% of cases were done under Proceduralist Directed Deep Sedation compared with 3.3% following the new requirement.

“There was little evidence to support the policy change with regard to patient safety or outcomes,” Osama Abdel-Hafez, MD, an internal medicine resident at the Indiana University School of Medicine, stated in a press release. “A policy that increases costs significantly without improvement in patient outcomes should be further reviewed.”

Deep sedation is not without complications,” Abdel-Hafez said. “However, there should be better selection of cases that need an anesthesiologist’s services. The CMS requirement was a blanket policy that covered all patients.”

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Disclosure: The study was self-funded by the Indiana University School of Medicine.