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. 2022 Nov;164(5):1561-1568.
doi: 10.1016/j.jtcvs.2021.04.074. Epub 2021 May 4.

Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries

Donald S Likosky  1 , Guangyu Yang  2 , Min Zhang  2 , Preeti N Malani  3 , Michael D Fetters  4 , Raymond J Strobel  5 , Carol E Chenoweth  3 , Hechuan Hou  6 , Francis D Pagani  6 ; Michigan Congestive Heart Failure Investigators
Collaborators, Affiliations

Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries

Donald S Likosky et al. J Thorac Cardiovasc Surg. 2022 Nov.

Abstract

Objective: The objective of this study was to investigate variations across hospitals in infection rates and associated costs, the latter reflected in 90-day Medicare payments. Despite high rates and expenditures of health care--associated infections associated with durable ventricular assist device implantation, few studies have examined interhospital variation and associated costs.

Methods: Clinical data on 8688 patients who received primary durable ventricular assist devices from July 2008 to July 2017 from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) were merged with postimplantation 90-day Medicare claims. Terciles of hospital-specific, risk-adjusted infection rates per 100 patient-months were estimated using Intermacs and associated with Medicare payments (among 5440 Medicare beneficiaries). Primary outcomes included infections within 90 days of implantation and Medicare payments.

Results: There were 3982 infections identified among 27.8% (2417/8688) of patients developing an infection. The median (25th, 75th percentile) adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 (9.3, 19.5) and varied according to hospital (range, 0.0-35.6). Total Medicare payments from implantation to 90 days were 9.0% (absolute difference: $13,652) greater in high versus low infection tercile hospitals (P < .0001). The period between implantation to discharge accounted for 73.1% of the difference in payments during the implantation to 90-day period across terciles.

Conclusions: Health care--associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures. Interventions targeting preventing infections could improve the value of durable ventricular assist device support from the societal and hospital perspectives.

Keywords: expenditure; infection; ventricular assist device.

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Conflict of interest statement

Donald S. Likosky received extramural support from the Agency for Healthcare Research and Quality (AHRQ, R01HS026003) and the National Heart, Lung, and Blood Institute (NHLBI – outside of this work).

Francis D. Pagani is a member of the scientific advisory board of FineHeart, Inc, member of the Data Safety Monitoring Board for Carmat, Inc, member of the Data Safety Monitoring Board for the National Heart, Blood, and Lung Institute PumpKIN clinical trial, and Chair of The STS Intermacs Task Force.

Data for this study were provided, in part, by Intermacs, previously funded, in part, by the NHLBI under Contract No. HHSN268201100025C. This study was undertaken prior to the acquisition of Intermacs by the Society of Thoracic Surgeons. Opinions expressed in this manuscript do not represent those of STS Intermacs, NHLBI, Centers for Medicare and Medicaid Services, the US Food and Drug Administration, the Agency for Healthcare Research and Quality, or the US Department of Health and Human Services.

Research use of these data was approved by Michigan Medicine’s Institutional Review Board (HUM00155687). Written informed consent for registrant participation in Intermacs was required until Protocol v4.0 (February 27, 2014).

Figures

Figure 1.
Figure 1.. Crude 90-day Hospital Healthcare-Associated Infection Rate (per 100 patient-months) Following Durable Ventricular Assist Device Implant
Distribution of crude 90-day hospital infection rates.
Figure 2.
Figure 2.. Mean Crude and Risk-Adjusted Cumulative Frequency of 90-day Hospital Healthcare-Associated Infection Rate Following Durable Ventricular Assist Device Implant
Overall (left panel), crude (center panel), and risk-adjusted (right panel) cumulative frequency of 90-day hospital infection rates, along with 95% confidence intervals. The center and right panels are stratified by tercile of hospital infection rates.
Figure 3.
Figure 3.. Study Design, Results and Implications
Adjusted incidence of infections varied by hospital, and total Medicare payments from implant to 90-days were 9.0% greater in high versus low infection tercile hospitals. Infection prevention could improve the value of durable ventricular assist devices.
None
Central Picture Legend:
Durable implant payments were 9% ($13,652) greater in high versus low infection terciles.
See this image and copyright information in PMC

Comment in

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