In June of this year, the Centers for Medicare and Medicaid Services (CMS) announced their decision to expand the existing coverage policy for transcatheter aortic valve replacement procedures—creating more flexible pre-procedure qualifications for providers, and ensuring improved care access for Medicare beneficiaries.
This minimally invasive procedure is just one of several surgical treatment options available to patients suffering from congenital heart defects or other forms of heart valve disease, including:
Mechanic valve replacement Damaged or diseased valve is replaced by one made of manufactured, carbon-based material
Tissue valve replacement Damaged or diseased valve is replaced by one made of animal tissue (either pig or cow)
Ross procedure Damaged or diseased aortic valve is replaced with a patient’s own healthy pulmonary valve
Medicare beneficiaries represent one of the largest patient demographics for cardiac valve replacement (CVR) procedures. In 2018, Definitive Healthcare tracked close to 92,000 inpatient Medicare claims for valve replacement procedures—a 4.6 percent increase from 2016 volumes.
The DHC Visuals platform provides an interactive, graphically engaging way for users to analyze these procedure claims both by region and by hospital view. In this blog, we’ll be highlighting certain hospital-level metrics available on the procedure analytics dashboard in order to understand the national scope of the cardiac valve replacement.
Hospitals in the southeast report highest CVR patient volumes
Fig 1 Map based on data from the Hospitals Cardiac Valve Procedure Analytics dashboard, available on the DHC Visuals platform. Information sourced from 2018 Medicare claims data, the most recent available.
With 25,000 total patients in 2018, Southeast hospitals reported the highest volumes of inpatient Medicare claims for cardiac valve replacement procedures—accounting for over 27 percent of the total market share. Facilities in this region also report the highest readmission rates, with an average 14.2 percent of Medicare patients readmitted within 30 days of hospital discharge. Greater patient volumes most likely account for the higher readmission rates reported at southeastern hospitals; with more people treated in a given claim year, care providers face a greater likelihood of encountering patient complications.
On a national scale, the average reported readmission rate is 13.4 percent for Medicare patients undergoing CVR procedures. Regionally, readmission rates are all within one percentage point of this national average.
Northeastern hospitals report the longest length of stay, with an average hospital stay of 7.33 days for Medicare patients undergoing cardiac valve replacement procedures. The lowest reported hospital stay is seen at facilities in both the southwest and western regions—with an average stay of 6.53 days.
Top hospitals by total patient admissions
Total Medicare Payments
Total Patient Admissions
Cleveland Clinic Main Campus
NY Presbyterian Weill Cornell Medical Center
Cedars-Sinai Medical Center
Mayo Clinic Hospital – St. Mary’s Campus
Mount Sinai Medical Center
Baylor Scott & White The Heart Hospital - Plano
MedStar Washington Hospital Center
Morristown Medical Center
St. Francis Hospital – The Heart Center
Sentara Norfolk General Hospital
Fig 2 Data accessed from the Hospitals Cardiac Valve Procedure Analytics dashboard, available on the DHC Visuals platform. Information sourced from 2018 Medicare claims data, the most recent available.
According to the most recent inpatient Medicare claims data, a total of 808 hospitals performed ten or more cardiac valve replacements in 2018, with an average of 115 procedures per hospital. Of those facilities, the Cleveland Clinic Main Campus ranks highest in terms of total CVR patient admissions, with 1,301 cardiac valve admissions last year. In fact, Cleveland Clinic has reported the highest CVR patient admissions for two years in a row.
Since 2015, the same hospitals—including Cleveland Clinic Main Campus, NY Presbyterian Weill Cornell Medical Center, Cedars-Sinai Medical Center, and Mayo Clinic Hospital (St. Mary’s Campus)—have consistently ranked within the top four facilities by total cardiac valve admissions, though their rankings have shifted slightly from year to year.
Interestingly, there seems to be little correlation between top hospitals and top regions by reported patient volumes. Southeast hospitals, for instance, have the greatest market share of Medicare CVR claims. Despite this, only two of the top ten hospitals by total cardiac valve admissions are located within this region. The northeast, in fact, has the greatest number of top hospitals by reported patient volumes.
More than half of CVR patients also diagnosed with hyperlipidemia
Fig 3 Top 10 cardiac valve replacement co-morbidities (by patient). Screenshot of a box chart available on the DHC Visuals Hospitals Cardiac Valve Procedure Analytics dashboard. Data is sourced from 2018 Medicare claims data, the most recent available.
On the DHC Visuals platform, users have access to interactive graphics—like the one shown above—that update with each new region, hospital, or market selected. Co-morbidity and inpatient procedure box charts are among those dynamic features available on the cardiac valve procedure dashboard—helping users understand the link between diagnosis and procedure claim types.
According to the above chart, more than half of the 93,000 Medicare patients admitted for a CVR procedure in 2018 were also diagnosed with hyperlipidemia, or high cholesterol. It’s no surprise that this condition would be a diagnosis shared among so many within the CVR patient population. High fat content in the blood can increase the risk of heart blockages or, in some cases, even valve calcification—requiring surgical intervention to repair or replace the damaged cardiac valve.
With 46,737 diagnoses in 2018, atherosclerotic heart disease—or plaque buildup in the coronary artery—is the second most commonly found condition among Medicare patients admitted for a CVR procedure. Personal history of nicotine dependence and prolonged use of aspirin are also among the most prevalent co-morbidities found within this patient population.
Understanding these claims metrics not only provides greater insight into the CVR patient demographic, but also enables others within the healthcare industry—medical device manufacturers, particularly—to have more informed conversations with care providers about treatment options specific to their unique patient needs. Interested in learning more about how DHC Visuals and the procedure area analytics dashboard can help you form strategies for effective targeting? Start a free trial today to see how you can:
Access interactive maps and visuals to understand key clinical and financial metrics
Segment your target market by region, CBSA, state, or health network
Trace both inbound and outbound referrals from destination hospitals