The volume of coronary artery bypass grafts in Pennsylvania has declined while the mortality rate for inpatients having a CABG has remained steady, but there remains an enormous variance in charges for procedures within the state and no discernible correlation between prices and outcomes, according to a March 2005 report by the Pennsylvania Health Care Cost Containment Council.
The publicly available report was based on risk-adjusted data from 15,117 procedures performed by 184 physicians in 61 non-Veterans Health Administration hospitals in Pennsylvania in 2003. It re-affirmed the oft-reported findings that physicians who do more procedures tend to have better outcomes than those who do fewer. It also appeared to show that price and outcomes are disconnected.
Hospitals in Pennsylvania are required to report the data to the council, a independent state agency, under state law. The council has published its CABG survey results intermittently since 1992.
The report noted that "it is not clear whether shorter lengths of stay are better than longer lengths of stay or vice versa," but also added a patient's length of stay "may reflect upon success of the treatment."
Physicians and hospitals were rated "lower than expected," "same as expected" or "higher than expected" on mortality rates for inpatients and at 30 days post-discharge and readmission rates at seven-day and 30-day intervals.
Joe Martin, the council's communications director, said there is some grumbling about the whether risk-adjustment was adequate, particularly after a hospital or doctor is tagged with a "higher-than-expected" outcomes indicator.
"I think mostly what they would say is they don't think the methodology completely captures all of the risk factors and all of the illness issues that are at play," Martin said. "But over time, more and more, I think there has been general acceptance by reasonable minds that we work as hard as we can to make this methodology as good as it can be."
The council is looking into obtaining data on actual revenue per procedure, but for now it still uses hospital charges as a placeholder for revenues, recognizing "probably about two-thirds is rubber," Martin said. "But it's two-thirds rubber for everybody," so the wide variance between providers still holds on revenues, too, with no apparent relationship between dollars and outcomes.
"That's been our experience over 10 or 12 years of reporting this," said Martin "There isn't a correlation. I doesn't always hold that more resources results in better care."
For example, 10 facilities with the lowest average charges (below $51,000 per procedure), also averaged 282 procedures a year. Combined, these lowest-charging facilities had two mortality/re-admissions ratings of "lower than expected," 34 of "same as expected" and four of "higher than expected."
Of the 10 facilities with the highest average charges, (greater than $163,000 per procedure), the average number of procedures was 143 for the year. These ten highest-charging hospitals had no mortality/readmission rankings of "lower than expected," 38 of "same as expected" and two of "higher than expected."
View the report.