Trends in Beneficiaries Served and Hospital Resources Used in Implantable Medical Device Procedures

GAO-12-583R: Published: May 14, 2012. Publicly Released: Jun 13, 2012.

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James C. Cosgrove
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What GAO Found

Overall, orthopedic IMD admission rates were substantially higher in 2009 compared with 2003, while admission rate patterns among cardiac IMDs were mixed. Admission rates rose for each of the orthopedic IMDs in our study, with knee replacement rates growing 6.7 percent per year. The picture for inpatient cardiac IMD procedures was more mixed; admission rates for dual-chamber pacemakers decreased steadily while rates for AICDs and drug-eluting stents increased through 2006 and generally declined thereafter, in part reflecting a shift of surgeries to the outpatient setting. While the proportion of both orthopedic and cardiac IMD beneficiaries in poor or very poor health grew throughout our period of study, this trend was far more evident for cardiac IMD beneficiaries after 2007.

Even with the increase in admissions of IMD beneficiaries in poorer health, overall lengths of stay for the IMD procedures we studied generally did not rise. Average lengths of stay for orthopedic IMD beneficiaries decreased from 2003 through 2009, while the lengths of stay for cardiac IMD beneficiaries fell through 2007 but increased thereafter. For all orthopedic IMD procedures in our study, lengths of stay declined during the period for beneficiaries in all reported health status groups. From 2003 through 2007, the average length of stay decreased among cardiac IMD beneficiaries in each health status group. From 2007 to 2009, average lengths of stay patterns varied by health status and specific cardiac IMD procedure.

Poorer health status and reductions in lengths of stay for inpatient IMD beneficiaries were not accompanied by an increase in discharges to rehabilitative facilities. Rather, the proportion of orthopedic IMD beneficiaries discharged to home health care increased substantially while the proportion discharged to a skilled nursing or rehabilitation facility dropped sharply. The discharge disposition pattern for cardiac IMD beneficiaries remained relatively stable throughout the study period, with a large majority of cardiac IMD beneficiaries discharged to home or self-care.

Why GAO Did This Study

The use of implantable medical devices (IMD) among Medicare beneficiaries is widely recognized as a way to prolong and improve the quality of life for patients that receive them. In 2009, about 1.6 million IMD procedures were performed on beneficiaries under traditional, fee-for-service Medicare at a cost of roughly $20 billion. Orthopedic and cardiac implantations—the most common IMD procedures provided to beneficiaries—accounted for nearly all IMD-related Medicare spending in that year. With beneficiaries expected to live longer and innovations in IMD technology, the use of orthopedic and cardiac IMDs is likely to continue to have important implications for hospital services paid for by Medicare.

The number of hospital admissions for IMD procedures, the duration of hospital stays, and the location to which patients are discharged are influenced by such factors as age and health status. In that light, Congress expressed interest in obtaining descriptive information about changes in the demographics of Medicare beneficiaries undergoing major IMD procedures and their use of hospital and postacute care resources. In this report, we examined three trends for Medicare beneficiaries who received orthopedic or cardiac IMDs: (1) hospital admission rates, by age and health status; (2) hospital lengths of stay, by health status; and (3) discharge disposition following admission for these procedures, by health status.

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