The U.S. healthcare system could save between $200 million and $500 million per year if 50 percent of percutaneous coronary intervention (PCI) patients were discharged the same day, as reported by JAMA Cardiology. A Canadian study showed that same-day discharge (SDD) after PCI was associated with a 50 percent reduction in costs, with a mean saving of U.S. $1,086 per patient, and European studies of this subject have also reported significant savings per patient.
Yet despite the evidence, many hospitals are still missing out on this significant savings opportunity and the rate of same-day discharge after PCI remains low.
According to a study of 672,470 patients undergoing elective PCI in 493 U.S. hospitals between 2006 and 2015, the average SDD rate was only 3.5 percent after adjustment for hospital variation. Adjusted annual rates increased steadily from 0.4 percent in 2006 to 6.3 percent in 2015, showing minor but continual progress. This particular study also determined that same-day discharge was not associated with higher rates of rehospitalization for bleeding, acute kidney injury, myocardial infarction, or mortality.
These findings pose an obvious question: Why is the rate of same-day discharge so low for PCI patients, given all its benefits? Another JAMA study of older PCI patients found that not only was SDD not significantly associated with an increased risk for either two-day or 30-day death or rehospitalization, but the median time to experience death or rehospitalization was 13-14 days—a time frame that would likely not be affected by an overnight stay. “Use of overnight observation is driven less by patient risk and more by either local practice patterns or other non-clinical reasons,” researchers concluded.
One non-clinical reason may be that inpatient PCI is reimbursed at a higher rate than outpatient PCI, during which the patient is discharged within 24 hours. However, most outpatient PCI patients in the United States are kept in the hospital overnight for 23 hours or less and thus occupy a bed either in a short-stay unit or inpatient ward. Another factor may be concern for early complications, even though the rates of vascular or bleeding complications were under 1 percent in the study of older PCI patients.
SDD is just one of many things that can be measured using analytics to identify avoidable costs that are hampering efforts to stay financially viable and having an adverse effect on patient satisfaction. For more, download “9 Ways to Boost Cardiovascular Service Line Margins and Quality” today.