PHC4 report offers transparency on cardiac procedure pricing

The Pennsylvania Cost Containment Council released its Cardiac Procedure Report today which includes data for six types of cardiac procedures performed in Pennsylvania hospitals. 

The data from Jan. 1, 2021, through Dec. 31, 2022, includes hospital specific volume and outcomes as well as Medicare fee-for-service figures and average hospital charges to allow for transparency for patients. 

“We know adding the surgical aortic valve replacement (SAVR) with coronary artery bypass graft (CABG) procedure to this report provides further value to stakeholders when assessing opportunities to prioritize resources,” said Barry D. Buckingham, PHC4’s executive director. 

Buckingham said PHC4 sees this as serving its mission to provide fact-based reporting to better inform decisions for all Pennsylvanians. The Cardiac Procedures Report can help consumers and purchasers make more informed health care decisions, while also aiding stakeholders in highlighting opportunities for quality improvement and cost containment. 

The six cardiac procedures reported are CABG, percutaneous coronary intervention (PCI) for patients who had a heart attack, PCI for patients who did not have a heart attack, transcatheter aortic valve replacement (TAVR), SAVR, and, newly added, SAVR with CABG. 

Coronary artery bypass graft 

In the report, PHC4 said, there were 16,900 hospitalizations for coronary artery bypass graft (CABG) procedures performed in Pennsylvania acute care hospitals. Of the hospitalizations, 13,426 cases, after exclusions, were examined in the Hospital Results section of this report in determining statewide rates of mortality, readmission and postoperative length of stay. 

The report shows the in-hospital mortality rate was 1.4%. Patients aged 85 and older had the highest mortality rate at 4.6%. Both Black (non-Hispanic) patients and White (non-Hispanic) patients had mortality rates of 1.3%, while Hispanic patients had a mortality rate of 1.2%. 

The report shows 3.9% of patients were readmitted to an acute care hospital within 7 days, 9.2% were readmitted within 30 days, and 14.2% were readmitted within 90 days.  

Black (non-Hispanic) patients had the highest 30-day readmission rate at 13.9%. Hispanic and White (non-Hispanic) patients had 30-day readmission rates of 12.1% and 8.8%, respectively, according to the report.  

Patients stayed in the hospital an average of 6.3 days following a CABG procedure. The report shows 3.9% of patients experienced an extended postoperative length of stay. 

 The average Medicare fee-for-service payment for hospitalizations was $40,860. The average Medicare fee-for-service payment for hospitalizations with an extended postoperative length of stay was $73,988.  

The report shows Lehigh Valley Hospital – Allentown performed 594 of these procedures at an average charge of $287,809; Lehigh Valley Hospital-Pocono performed 79 at an average charge of $229,001; Reading Hospital, 252 for $183,675; St. Luke’s University Hospital – Bethlehem Campus, 547 at $354,462; and Penn State Health St. Joseph Medical Center, 120 at $184,291. 

Percutaneous coronary intervention (PCI) procedure for a heart attack 

The report, which looked at 23,419 cases, after exclusions, for patients who underwent a percutaneous coronary intervention (PCI) procedure for a heart attack, shows the in-hospital mortality rate was 1.8%. Patients aged 85 and older had the highest mortality rate at 4.7%. White (non-Hispanic) and Black (non-Hispanic) patients had mortality rates of 1.9% and 0.7%, respectively. Hispanic patients had a mortality rate of 0.8%.  

The report shows 3.5% were readmitted within 7 days, 8.2% were readmitted within 30 days, and 13.9% were readmitted within 90 days. Black (non-Hispanic) patients had the highest 30-day readmission rate at 10.4%. White (non-Hispanic) and Hispanic patients had 30-day readmission rates of 8.1% and 7.6%, respectively, the report shows.  

Patients stayed in the hospital an average of 2.3 days following a PCI procedure. The report shows 3.7% of patients experienced an extended postoperative length of stay. 

The average Medicare fee-for-service payment was $16,267 and $22,106 for extended stays.  

The data shows Lehigh Valley Hospital – Allentown performed 977 at an average charge of $185,828; Lehigh Valley Hospital – Pocono, 217 at $121,706; Reading Hospital, 433 at $90,369; St. Luke’s Anderson, 212 at $127,570; St. Luke’s Bethlehem, 521 at $136,982; St. Luke’s Monroe, 169 at $149,560; and Penn State St. Joseph, 217 at $125,143. 

Percutaneous coronary intervention 

There were 12,630 hospitalizations for patients who underwent percutaneous coronary intervention (PCI) procedures performed during the period. The report examined 9,323 cases, after exclusions.  Patients who had a heart attack are not included. 

In the report, the in-hospital mortality rate was 1.3%. Mortality ratings are not reported for hospitals and are not displayed in the Hospital Results section of the report due to the small number of mortalities statewide, PCH4 said. 

The report shows 4.7% of patients were readmitted within 7 days, 12.4% were readmitted within 30 days, and 22.1% were readmitted within 90 days.  

Hispanic patients had the highest 30-day readmission rate at 15.7%. Black (non-Hispanic) and White (non-Hispanic) patients had 30-day readmission rates of 13.1% and 12.4%, respectively, according to the report.  

Patients stayed in the hospital an average of 2.1 days following a PCI procedure and 4.4% of patients experienced an extended postoperative length of stay.  

The report shows 4.7% of patients were readmitted within 7 days, 12.4% were readmitted within 30 days, and 22.1% were readmitted within 90 days.  

Hispanic patients had the highest 30-day readmission rate at 15.7%. Black (non-Hispanic) and White (non-Hispanic) patients had 30-day readmission rates of 13.1% and 12.4%, respectively, according to the report. 

Patients stayed in the hospital an average of 2.1 days following a PCI procedure. The report shows 4.4% of patients experienced an extended postoperative length of stay.  

The average Medicare fee-for-service payment for hospitalizations was $17,990, and $23,219 for extended stays.  

Locally, the report shows Lehigh Valley Allentown performed 14 procedures for an average charge of $187,725; Lehigh Valley Pocono, 68 at $128,934; Reading Hospital, 165 at $95,821; St. Luke’s Anderson, 77 at $123,483; St. Luke’s Bethlehem, 257 at $148,593; St. Luke’s Monroe, 116 at $157,350; and Penn State St. Joseph, 111 at $128,875. 

Surgical aortic valve replacement 

There were 6,143 hospitalizations for surgical aortic valve replacement (SAVR) procedures performed during the period. PHC4 examined 3,151 cases, after exclusions, which showed the in-hospital mortality rate was 1.9%. 

 Patients aged 85 and older had the highest mortality rate at 16.7%. Black (non-Hispanic) patients had a mortality rate of 4.8%. Hispanic and white (non-Hispanic) patients had mortality rates of 2.7% and 1.6%, respectively, the report shows. 

According to the PHC4 data, 4.2% of patients were readmitted within 7 days, 10.0% were readmitted within 30 days, and 13.2% were readmitted within 90 days.  

Black (non-Hispanic) patients had the highest 30-day readmission rate at 18.0%. Hispanic and White (non-Hispanic) patients had 30-day readmission rates of 11.6% and 9.6%, respectively. Patients stayed in the hospital an average of 6.8 days following a SAVR procedure and 3.7% of patients experienced an extended postoperative length of stay.   

The average Medicare fee-for-service payment was $54,532 and $101,160 for extended stays.  

Lehigh Valley Allentown performed 152 procedures at an average charge of $343,983; Lehigh Valley Pocono, 20 at $307,863; Reading Hospital, 35 at $237,034; St. Luke’s Bethlehem, 101 at $408,142; and Penn State St. Joseph, 23 at $181,673, according to the report. 

Surgical aortic valve replacement (SAVR) with coronary artery bypass graft 

Of the 1,989 hospitalizations for surgical aortic valve replacement (SAVR) with coronary artery bypass graft (CABG) procedures performed, PHC4 examined 1,856 cases, after exclusions, finding the in-hospital mortality rate was 4.3%. 

Patients aged 85 and older had the lowest mortality rate at 2.6%. Black (non-Hispanic) patients had a mortality rate of 9.3%. White (non-Hispanic) and Hispanic patients had mortality rates of 4.0% and 0.0%, respectively, the report shows. 

The report shows 6.0% of patients were readmitted to an acute care hospital within 7 days, 13.3% were readmitted within 30 days, and 19.0% were readmitted within 90 days. 

 Black (non-Hispanic) patients had the highest 30-day readmission rate at 20.0%. Hispanic and White (non-Hispanic) patients had 30-day readmission rates of 13.6% and 13.3%, respectively. Patients stayed in the hospital an average of 8.2 days following a SAVR with CABG procedure and 4.3% of patients experienced an extended postoperative length of stay, the report shows. 

The average postoperative stay for these patients was 26.4 days. The average Medicare fee-for-service payment was $58,454 and the average Medicare fee-for-service payment for hospitalizations with an extended postoperative length of stay was $105,742, the report shows.  

Lehigh Valley Allentown performed 97 procedures at an average charge of $418,853; Lehigh Valley Pocono, 13 with no charge reported; Reading Hospital, 19 at $258,987; St. Luke’s Bethlehem, 63 at $491,467; and Penn State St. Joseph, 8 at $307,128, the data shows. 

Transcatheter aortic valve replacement 

Finally, the report showed10,192 hospitalizations for transcatheter aortic valve replacement (TAVR) procedures, of which 9,941 cases, after exclusions, were examined. 

The in-hospital mortality rate was 0.7%. The report shows 4.7% of patients were readmitted to an acute care hospital within 7 days, 9.6% were readmitted within 30 days, and 16.2% were readmitted within 90 days.  

Black (non-Hispanic) patients had the highest 30-day readmission rate at 12.7%. Hispanic and White (non-Hispanic) patients had 30-day readmission rates of 11.1% and 9.6%, respectively. Patients stayed in the hospital an average of two days following a TAVR procedure and 5.5% of patients experienced an extended postoperative length of stay.  

The average Medicare fee-for-service payment was $46,013 and the average Medicare fee-for-service payment for hospitalizations with an extended postoperative length of stay was $55,468, the report shows. 

Lehigh Valley Allentown performed 457 procedures at an average charge of $466,234; Reading Hospital, 166 at $178,642; St. Luke’s Bethlehem, 466 at $438,133; and Penn State St. Joseph, 89 at $214,538, according to the report.