Faculty Collaboration Database

The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions. Catheter Cardiovasc Interv 2023 Jun;101(7):1193-1202

Date

04/27/2023

Pubmed ID

37102376

DOI

10.1002/ccd.30670

Scopus ID

2-s2.0-85156229698 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an increasingly used but relatively expensive procedure with substantial associated readmission rates. It is unknown how cost-constrictive payment reform measures, such as Maryland's All Payer Model, impact TAVR utilization given its relative expense. This study investigated the impact of Maryland's All Payer Model on TAVR utilization and readmissions among Maryland Medicare beneficiaries.

METHODS: This was a quasi-experimental investigation of Maryland Medicare patients undergoing TAVR between 2012 and 2018. New Jersey data were used for comparison. Longitudinal interrupted time series analyses were used to study TAVR utilization and difference-in-differences analyses were used to investigate post-TAVR readmissions.

RESULTS: During the first year of payment reform (2014), TAVR utilization among Maryland Medicare beneficiaries dropped by 8% (95% confidence interval [CI]: -9.2% to -7.1%; p < 0.001), with no concomitant change in TAVR utilization in New Jersey (0.2%, 95% CI: 0%-1%, p = 0.09). Longitudinally, however, the All Payer Model did not impact TAVR utilization in Maryland compared to New Jersey. Difference-in-differences analyses demonstrated that implementation of the All Payer Model was not associated with significantly greater declines in 30-day post-TAVR readmissions in Maryland versus New Jersey (-2.1%; 95% CI: -5.2% to 0.9%; p =0.1).

CONCLUSIONS: Maryland's All Payer Model resulted in an immediate decline in TAVR utilization, likely a result of hospitals adjusting to global budgeting. However, beyond this transition period, this cost-constrictive reform measure did not limit Maryland TAVR utilization. In addition, the All Payer Model did not reduce post-TAVR 30-day readmissions. These findings may help inform expansion of globally budgeted healthcare payment structures.

Author List

Yesantharao PS, Etchill EW, Zhou AL, Ong CS, Metkus TS, Canner JK, Alejo DE, Aliu O, Czarny MJ, Hasan RK, Resar JR, Schena S

Author

Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aortic Valve
Aortic Valve Stenosis
Humans
Maryland
Medicare
Patient Readmission
Risk Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
United States