After he arrived at the emergency room, a cardiologist performed an emergency cardiac catheterization, known as a percutaneous coronary intervention, or PCI. He snaked a thin tube from Charles' groin through his blood vessels to his heart, broke up a blood clot, and left behind a metal stent to keep the artery open. Charles, who didn't want his last name used for this article, spent four days in the hospital and later returned for routine follow-up care.
Charles, now 60, didn't know it at the time, but the hospital he chose, Forsyth, has a lower risk-adjusted readmission rate following PCIs than the other major local hospital that performs PCI procedures, Wake Forest Baptist Medical Center, according to data published by the CMS this past summer. He also didn't know that Forsyth—now called Novant Health Forsyth Medical Center—also has a lower average cost for performing the procedure, according to data compiled by the American Hospital Directory.
The data show that it cost Novant Health Forsyth about $12,000 on average to deliver 195 inpatient PCIs in 2011, compared with about $18,000 apiece for 350 PCI procedures at Wake Forest Baptist. At the same time, Novant Health Forsyth had a lower 30-day readmission rate for PCI patients in 2011 than Wake Forest Baptist—10.3% vs. 13.2%. The national average was 11.9%. The CMS and many experts consider readmission rates a valid indicator of quality of care, arguing that patients are less likely to need a hospital stay within 30 days if they received high-quality care.
Similarly, in Lincoln, Neb., the Nebraska Heart Institute and Heart Hospital reported an average cost of about $7,900 to perform inpatient PCIs in 2011 compared with about $17,000 at BryanLGH Medical Center. Meanwhile, Nebraska Heart had one of the lowest risk-adjusted readmission rates in the country for PCI patients in 2011, at 9.1%, compared with 11.7% at BryanLGH. Nebraska Heart was acquired by Catholic Health Initiatives in late 2011.
Similar disconnects between lower costs and better outcomes are not unusual. A Modern Healthcare analysis found that in seven of 12 cities examined, the hospital with the lower average cost for inpatient and outpatient PCI procedures also had a lower readmission rate for PCI patients. In the other five cities, hospitals with a higher average cost had lower readmission rates.
“Just because your insurance company paid a whole lot for your hospitalization doesn't mean it was good quality to you,” said Dr. Gregg Fonarow, co-director of the UCLA Preventative Cardiology Program in Los Angeles. He hopes more findings such as those on the costs and quality for PCI procedures will focus healthcare providers and insurers on delivering value to patients. “The hope is, with continued reporting of outcomes metrics and the beginning of reporting of cost and charge data, we can get there,” he said.
Chapin White, a senior health researcher at the Center for Studying Health System Change, said, “The raw material is there for a good conversation about which hospitals are expensive, which hospitals are cheap, and are we getting our money's worth from the expensive hospitals.”