Declining Use Rates of Revascularization for Medicare Patients

The report by Culler and associates in this issue of Circulation provides useful information about the trends and outcomes of coronary revascularization procedures currently being performed in the United States1. Data acquisition for this analysis of coronary revascularization activity from 2008 through 2012 required tedious mining of 2 complex data sets maintained by the Centers for Medicare and Medicaid Services (CMS). In addition to the Medicare Provider Analysis and Review (MedPAR) file which contains all inpatient claims for Medicare beneficiaries, they reviewed the Medicare Outpatient File which contains claims for "non-admission" services, specifically data on outpatient procedures. This latter review was necessary since many percutaneous coronary interventions (PCI) are now done in acute hospital settings, but with patients classified as outpatients or hospitalized but under observation status. An obvious limitation of this report of current revascularization trends is the fact that only Medicare patient data were analyzed. Coronary revascularizations of Medicare beneficiaries, however, are believed to represent a modest majority of such procedures and reliably reflect total revascularization activity in the United States.