Afana Majed, Brinjikji Waleed, Cloft Harry, Salka Samer
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Clin Cardiol. 2015 Jan;38(1):13-9. doi: 10.1002/clc.22341. Epub 2014 Oct 21.
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.
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.
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.
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.
急性冠状动脉综合征占心血管疾病所致死亡的一半，在美国构成了巨大的经济负担。因此，评估这些患者的住院费用相对于医疗保险报销情况，对于理解这些患者对医院的影响至关重要。我们假设接受经皮冠状动脉介入治疗（PCI）的急性心肌梗死患者的住院费用高于其相关的医疗保险支付金额。
利用全国住院患者样本，我们通过将医院收费乘以每位患者住院期间的组平均成本与收费比率，评估了2001年至2009年接受PCI治疗的患者的住院费用。所检查的主要终点是总住院费用及随时间的趋势，这些与临床结局和保险支付相关。费用以2009年为基准年进行了通胀调整。
PCI的住院费用中位数从2001年的15889美元（四分位间距[IQR] = 12057 - 21204美元）增至2009年的19349美元（IQR = 14660 - 26282美元）。从2004年到2009年，经通胀调整的PCI费用以每年0.3%的速度下降。2009年，共有265531例患者因急性心肌梗死接受了PCI治疗。其中，143654例年龄小于65岁，121876例年龄大于或等于65岁。根据所计费的医疗保险严重程度诊断相关组（MS - DRG），2009年医疗保险的平均支付金额在9303美元至17500美元之间，在比较所有纳入的MS - DRG编码的成本和报销情况时，医院每位患者亏损4493美元至7940美元不等。
在过去几年中，接受PCI治疗患者的住院费用一直趋于稳定；然而，医疗保险报销与住院费用之间仍存在显著差距，这对患者结局、医疗质量和医院可持续性可能产生影响。
