PATIENT SAFETY Comparison of Hospitalization Costs and Medicare Payments for Carotid Endarterectomy and Carotid Stenting in Asymptomatic Patients

BACKGROUND AND PURPOSE: Hospitals struggle to provide care for elderly patients based on Medi-care payments. Amid concerns of inadequate reimbursement, we sought to evaluate the hospitaliza-tion costs for recipients of CEA and CAS placement, identify variables associated with increased costs, and compare these costs with Medicare reimbursements. MATERIALS AND METHODS: All CEA and CAS procedures were extracted from the 2001–2008 NIS. Average CMS reimbursement rates for CEA and CAS were obtained from www.CMS.gov. Annual trends in hospital costs were analyzed by Sen slope analysis. Associations between LOS and hospital costs with respect to sex, age, discharge status, complication type, and comorbidity were analyzed by using the Wilcoxon rank sum test. Least-squares regression models were used to predict which variables had the greatest impact on LOS and hospital costs. RESULTS: The 2001–2008 NIS contained 181,200 CEA and 12,485 CAS procedures. Age and sex were not predictive of costs for either procedure. Among favorable outcomes, CAS was associated with significantly higher costs compared with CEA (P .0001). Average Medicare payments were $1,318 less than costs for CEA and $3,241 less than costs for CAS among favorable outcomes. Greater payment-to-cost disparities were noted for both CEA and CAS in patients who had unfavorable outcomes. CONCLUSIONS: The 2008 Medicare hospitalization payments were substantially less than median hospital costs for both CAS and CEA. Efforts to decrease hospitalization costs and/or increase payments will be necessary to make these carotid revascularization procedures economically viable for hospitals in the long term. ABBREVIATIONS: ARF acute renal failure; CAS carotid artery stent; CC comorbid condition; CCS clinical classification software; CEA carotid endarterectomy; CHF congestive hear