Comparison of hospitalization costs and medicare payments for carotid endarterectomy and carotid stenting in asymptomatic patients

Abstract

BACKGROUND AND PURPOSE: Hospitals struggle to provide care for elderly patients based on Medicare payments. Amid concerns of inadequate reimbursement, we sought to evaluate the hospitalization 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