Background Hospitals struggle to provide care for elderly patients based on Medicare payments. Amidst concerns of inadequate reimbursement, we sought to evaluate the hospitalization costs for recipients of carotid endarterectomy (CEA) and carotid artery stenting (CAS), identify variables associated with increased costs, and compare these costs to Medicare reimbursements.
Methods All CEA and CAS procedures were extracted from the 2001–2008 National Inpatient Sample. Average CMS reimbursement rates for CEA and CAS were obtained from CMS.gov. Annual trends in hospital costs were analyzed by Sen's slope analysis. Associations between length of stay and hospital costs with respect to gender, age, discharge status, complication type, and co-morbidity were analyzed using the Wilcoxon rank sum test. Least-squares regression models were used to predict which variables had the greatest impact on LOS and hospital costs.
Results The 2001–2008 National Inpatient Sample contained 181 200 CEA and 12 485 CAS procedures. Age and gender were not predictive of costs for either procedure. Among favorable outcomes, CAS was associated with significantly higher costs compared to CEA (p<0.0001). Average Medicare payments were US$1318 less than costs for CEA and US$3241 less than costs for CAS among favorable outcomes. Greater payment-to-cost disparities were noted for both CEA and CAS in patients who had unfavorable outcomes.
Conclusions The 2008 Medicare hospitalization payments were substantially less than median hospital costs for both CAS and CEA. Efforts to decrease hospitalization costs and/or increase payments will be necessary to make these carotid revascularization procedures economically viable for hospitals in the long-term.
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Disclosures R McDonald: None. D Kallmes: Cordis, Microvention, Penumbra, NFocus, Sequent, ev3. H Cloft: Cordis, Mindframe, Microvention, Medtronic.