The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions
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 r...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2023-06, Vol.101 (7), p.1193-1202 |
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| creator | Yesantharao, Pooja S. Etchill, Eric W. Zhou, Alice L. Ong, Chin Siang Metkus, Thomas S. Canner, Joseph K. Alejo, Diane E. Aliu, Oluseyi Czarny, Matthew J. Hasan, Rani K. Resar, Jon R. Schena, Stefano |
| description | 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 |
| doi_str_mv | 10.1002/ccd.30670 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2806997046</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2824223479</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3480-89711841cca9238a69d1671fd51eb98e5d5bee73f4b89634ff46ef779d8b2e83</originalsourceid><addsrcrecordid>eNp10UuLFDEQB_AgivvQg19AAl52D7Ob1-RxXEZdhQVBBvHWVCfVbJZ-maRnGT-9cWf0IHhKBX71p6gi5A1nV5wxce19uJJMG_aMnPK1ECsj9Pfnx5o7pU_IWc4PjDGnhXtJTqThTEijT8lue480DjP4QqeOAs0FCj7GgHSG_YBjoQm7KQ10GmlJMGYP5R4LJgpTKtHTHfQ7rGjuweNTw8X25tvXS7qU2MefUGLthDFUAmGIOdd_fkVedNBnfH18z8n244ft5tPq7svt583N3cpLZdnKOsO5Vdx7cEJa0C5wbXgX1hxbZ3Ed1i2ikZ1qrdNSdZ3S2Bnjgm0FWnlOLg6xc5p-LJhLUwfw2Pcw4rTkRlimnTNM6Urf_UMfpiWNdbiqhBJCKuOqujwon6ac62aaOcUB0r7hrPl9i6beonm6RbVvj4lLO2D4K_8sv4LrA3iMPe7_n9RsNu8Pkb8AvfOTag</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2824223479</pqid></control><display><type>article</type><title>The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Yesantharao, Pooja S. ; Etchill, Eric W. ; Zhou, Alice L. ; Ong, Chin Siang ; Metkus, Thomas S. ; Canner, Joseph K. ; Alejo, Diane E. ; Aliu, Oluseyi ; Czarny, Matthew J. ; Hasan, Rani K. ; Resar, Jon R. ; Schena, Stefano</creator><creatorcontrib>Yesantharao, Pooja S. ; Etchill, Eric W. ; Zhou, Alice L. ; Ong, Chin Siang ; Metkus, Thomas S. ; Canner, Joseph K. ; Alejo, Diane E. ; Aliu, Oluseyi ; Czarny, Matthew J. ; Hasan, Rani K. ; Resar, Jon R. ; Schena, Stefano</creatorcontrib><description>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.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.30670</identifier><identifier>PMID: 37102376</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Aortic valve ; Aortic Valve - surgery ; Aortic Valve Stenosis - surgery ; global hospital budgets ; Humans ; Maryland ; Maryland All Payer system ; Medicare ; Patient Readmission ; payment reform ; readmissions ; Risk Factors ; TAVR ; Transcatheter Aortic Valve Replacement - adverse effects ; Treatment Outcome ; United States</subject><ispartof>Catheterization and cardiovascular interventions, 2023-06, Vol.101 (7), p.1193-1202</ispartof><rights>2023 The Authors. published by Wiley Periodicals LLC.</rights><rights>2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3480-89711841cca9238a69d1671fd51eb98e5d5bee73f4b89634ff46ef779d8b2e83</cites><orcidid>0000-0001-6593-3985</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.30670$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.30670$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37102376$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yesantharao, Pooja S.</creatorcontrib><creatorcontrib>Etchill, Eric W.</creatorcontrib><creatorcontrib>Zhou, Alice L.</creatorcontrib><creatorcontrib>Ong, Chin Siang</creatorcontrib><creatorcontrib>Metkus, Thomas S.</creatorcontrib><creatorcontrib>Canner, Joseph K.</creatorcontrib><creatorcontrib>Alejo, Diane E.</creatorcontrib><creatorcontrib>Aliu, Oluseyi</creatorcontrib><creatorcontrib>Czarny, Matthew J.</creatorcontrib><creatorcontrib>Hasan, Rani K.</creatorcontrib><creatorcontrib>Resar, Jon R.</creatorcontrib><creatorcontrib>Schena, Stefano</creatorcontrib><title>The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>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.</description><subject>Aged</subject><subject>Aortic valve</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>global hospital budgets</subject><subject>Humans</subject><subject>Maryland</subject><subject>Maryland All Payer system</subject><subject>Medicare</subject><subject>Patient Readmission</subject><subject>payment reform</subject><subject>readmissions</subject><subject>Risk Factors</subject><subject>TAVR</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp10UuLFDEQB_AgivvQg19AAl52D7Ob1-RxXEZdhQVBBvHWVCfVbJZ-maRnGT-9cWf0IHhKBX71p6gi5A1nV5wxce19uJJMG_aMnPK1ECsj9Pfnx5o7pU_IWc4PjDGnhXtJTqThTEijT8lue480DjP4QqeOAs0FCj7GgHSG_YBjoQm7KQ10GmlJMGYP5R4LJgpTKtHTHfQ7rGjuweNTw8X25tvXS7qU2MefUGLthDFUAmGIOdd_fkVedNBnfH18z8n244ft5tPq7svt583N3cpLZdnKOsO5Vdx7cEJa0C5wbXgX1hxbZ3Ed1i2ikZ1qrdNSdZ3S2Bnjgm0FWnlOLg6xc5p-LJhLUwfw2Pcw4rTkRlimnTNM6Urf_UMfpiWNdbiqhBJCKuOqujwon6ac62aaOcUB0r7hrPl9i6beonm6RbVvj4lLO2D4K_8sv4LrA3iMPe7_n9RsNu8Pkb8AvfOTag</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Yesantharao, Pooja S.</creator><creator>Etchill, Eric W.</creator><creator>Zhou, Alice L.</creator><creator>Ong, Chin Siang</creator><creator>Metkus, Thomas S.</creator><creator>Canner, Joseph K.</creator><creator>Alejo, Diane E.</creator><creator>Aliu, Oluseyi</creator><creator>Czarny, Matthew J.</creator><creator>Hasan, Rani K.</creator><creator>Resar, Jon R.</creator><creator>Schena, Stefano</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6593-3985</orcidid></search><sort><creationdate>20230601</creationdate><title>The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions</title><author>Yesantharao, Pooja S. ; Etchill, Eric W. ; Zhou, Alice L. ; Ong, Chin Siang ; Metkus, Thomas S. ; Canner, Joseph K. ; Alejo, Diane E. ; Aliu, Oluseyi ; Czarny, Matthew J. ; Hasan, Rani K. ; Resar, Jon R. ; Schena, Stefano</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3480-89711841cca9238a69d1671fd51eb98e5d5bee73f4b89634ff46ef779d8b2e83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Aortic valve</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>global hospital budgets</topic><topic>Humans</topic><topic>Maryland</topic><topic>Maryland All Payer system</topic><topic>Medicare</topic><topic>Patient Readmission</topic><topic>payment reform</topic><topic>readmissions</topic><topic>Risk Factors</topic><topic>TAVR</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yesantharao, Pooja S.</creatorcontrib><creatorcontrib>Etchill, Eric W.</creatorcontrib><creatorcontrib>Zhou, Alice L.</creatorcontrib><creatorcontrib>Ong, Chin Siang</creatorcontrib><creatorcontrib>Metkus, Thomas S.</creatorcontrib><creatorcontrib>Canner, Joseph K.</creatorcontrib><creatorcontrib>Alejo, Diane E.</creatorcontrib><creatorcontrib>Aliu, Oluseyi</creatorcontrib><creatorcontrib>Czarny, Matthew J.</creatorcontrib><creatorcontrib>Hasan, Rani K.</creatorcontrib><creatorcontrib>Resar, Jon R.</creatorcontrib><creatorcontrib>Schena, Stefano</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yesantharao, Pooja S.</au><au>Etchill, Eric W.</au><au>Zhou, Alice L.</au><au>Ong, Chin Siang</au><au>Metkus, Thomas S.</au><au>Canner, Joseph K.</au><au>Alejo, Diane E.</au><au>Aliu, Oluseyi</au><au>Czarny, Matthew J.</au><au>Hasan, Rani K.</au><au>Resar, Jon R.</au><au>Schena, Stefano</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>101</volume><issue>7</issue><spage>1193</spage><epage>1202</epage><pages>1193-1202</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37102376</pmid><doi>10.1002/ccd.30670</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-6593-3985</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Catheterization and cardiovascular interventions, 2023-06, Vol.101 (7), p.1193-1202 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Aortic valve Aortic Valve - surgery Aortic Valve Stenosis - surgery global hospital budgets Humans Maryland Maryland All Payer system Medicare Patient Readmission payment reform readmissions Risk Factors TAVR Transcatheter Aortic Valve Replacement - adverse effects Treatment Outcome United States |
| title | The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions |
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