Inpatient or Outpatient Status for Elective Percutaneous Coronary Intervention

Doctor, “you gotta let me know. Should I stay or should I go?” This (modified) version of The Clash’s song is a fundamental question for physicians and patients after elective percutaneous coronary intervention (PCI). In the current paradigm, third-party payers dictate that the vast majority of patients irrespective of risk should go. The driving force behind this is almost entirely financial. We think this care paradigm must evolve. The Centers for Medicare and Medicaid Services (CMS) is the largest payer for PCI procedures in the United States. In recent years, CMS has made several modifications to reimbursement for PCI procedures.1,2 An important aspect of reimbursement is whether PCI is performed in an inpatient or outpatient setting. Although these are fairly intuitive terms, they are in fact not related to duration of hospitalization and historically have carried different implications for reimbursement purposes. Overall, there appeared to be a significant financial advantage to institutions for performing inpatient PCI: reimbursement under the more lucrative Diagnostic-Related Group system rather than the Ambulatory Payment Classification system, as also illustrated by Vora et al in this issue of Circulation: Cardiovascular Interventions .3 What is interesting is that, in this construct, an outpatient PCI could in fact be in the hospital for several days after, whereas an inpatient PCI could be discharged the next day.See Article by Vora et al Recognizing that cardiovascular services, particularly inpatient procedures, contributed heavily to escalating healthcare costs, CMS pursued several measures to rein in costs and reduce overpayments. One of them was …