Nearly two thirds (64.3%) of cath lab staff believe that the financial/administrative burdens of meeting percutaneous coronary intervention (PCI) public reporting requirements are not outweighed by the potential benefits in terms of improving quality of care. Furthermore, the median institutional costs to meet public reporting requirements are US$100,000 to US$200,000 and interventional cardiologists spend a median time of five to 10 hours per week on meeting these requirements.
Rishi K Wadhera (Richard A and Susan F Smith, Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical and Harvard Medical School, Boston, USA) and others report in the Journal of the American College of Cardiology that the aim of PCI public reporting (of mortality rates) programmes in the USA is “to incentivise physicians and institutions to improve care and to provide patients with information to make informed decisions about where to seek care”. However, they add that the evidence suggests such programmes “has not clearly led to improvements in quality of care or patient outcomes”. “Consequently, some physicians and policymakers have expressed concern that reporting may impose a significant financial and administrative burden on physicians and hospitals without improving care,” Wadhera et al comment.
Given little data for the financial and administrative burdens associated with public reporting are available, the aim of the present study was to survey Massachusetts cath labs that participate in public reporting programmes about these burdens. Of 24 cath labs contacted, 15 responded. The authors state: “Respondents were more likely to be from cardiac catheterisation laboratories at large hospitals (>400 beds; 53.3% vs. 0%) and teaching institutions (53.3% vs, 22.2%). In addition, respondents, more often had cardiothoracic surgery available onsite (73.4% vs. 44.5%) and higher mean annual PCI volumes (491 vs. 314).”
They found that the median estimated range of annual institutional costs to meet state public reporting requirements was US$100,000–200,000 (range US$0–50,000 to >US$300,000), the median number of full-time equivalent staff employed to handle public reporting requirements was one (range 0.5–2.75), and the median time spent by an interventional cardiologist to meet the requirements was five to 10 hours per week (0–5 hours to >20 hours per week). Of note, according to Wadhera et al, “most respondents felt that the potential benefits of PCI public reports to quality of care and healthcare transparency did not weigh the administrative and/or financial burden (64.3%)”.
The authors observe that the “little evidence” that public reporting leads to improving outcomes has prompted debate about the value of public reporting programme, adding that survey data suggest “patients undergoing PCI are unaware of and rarely use publicly reported information”. Additionally, public reporting, Wadhera et al state, “has pushed physicians to avoid high-risk but indicated PCIs”. “Lower rates of PCI in reporting states, for instance, have been most pronounced among patients who may stand to gain the most from intervention, such as those with acute myocardial infarction complicated by cardiogenic shock,” the authors explain.
Summarising the findings of the survey, the authors write: “Our study raises concerns that this policy, which has not clearly improved patient outcomes, has also imposed financial and administrative burdens on physicians and institutions.” “As public reporting continues to expand nationally under the American College of Cardiology, it will be important to ensure these efforts are efficient and do not result in excessive cost and administrative burden to physicians and institutions,” they add.
Senior author Robert Yeh (Richard A and Susan F Smith, Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical and Harvard Medical School, Boston, USA) told Cardiovascular News: “Many cath labs have robust internal quality improvement programmes that include reviewing adverse events and challenging cases that may have a more positive impact on care quality than public reporting policies do, so it is not clear that these policies add anything more than administrative and financial burden. Here is a case where an alternative to public reporting, namely a strong cath lab quality insurance programme, already exists. There is of course no free lunch, since even these internal quality insurance programmes need to be well resourced, have an effective physician champion, and be backed by organisational leadership in order to succeed.”