Heart Valve Replacement Surgeries Have a Higher Case Mix Index When There is Cardiac Catheterization

In Heart Failure

By: James Pitt  Aug. 17, 2018

The Centers for Medicare and Medicaid Services reimburses heart valve procedures based on which of six diagnosis-related groups (DRGs) they fall in. These groups are based on whether there were complications/ comorbidities (CCs) and on whether cardiac catheterization was used.

Dexur analysts examined the case mix of heart valve procedures at six large hospitals in New York State. National data is not enough to predict hospital-level trends.

Major complications/ comorbidities (MCCs) are generally more common in patients who receive cardiac catheterization than in patients who do not.

Heart Value Replacement Complications, with vs without Cardiac Cath

This is consistent with national trends.

This does not imply that cardiac catheterization leads to complications. It is likely that surgeons opt to catheterize more often in higher-risk patients. However, a 2010 retrospective analysis at University of Virginia found that renal failure was more common (odds ratio 5.3) in valve replacement patients with cardiac catheterization within 24 hours of their procedure than in other valve replacement patients.

Nationally, there are more valve procedures without catheterization than with catheterization. However, many individual hospitals do not conform to the national trends. Winthrop - University Hospital (Mineola, NY), Rochester General Hospital (Rochester, NY), and Stony Brook University Hospital (Stony Brook, NY) performed more valve procedures with catheterization than without.

There were 287, 253 cardiac valve procedures nationwide from Jan 2013 to Dec 2017 among Medicare-eligible inpatients.

Aortic and mitral valves are the most commonly replaced heart valves. (Tricuspid and pulmonary valve replacements are rarer). Valve replacement options include purely mechanical valves and human or animal donor tissue valves.


For DRGs 216, 217, 218, 219, 200, and 221:

  1. Total DRG Discharges
  2. Total Heart Failure Discharges at DRG
  3. % of Heart Failure Discharges at DRG
  4. State % of Heart Failure Discharges at DRG
  5. National % of Heart Failure Discharges at DRG

At the following hospitals:

  1. Rochester General Hospital (Rochester, NY)
  2. St Josephs Hospital Health Center (Syracuse, NY)
  3. Winthrop - University Hospital (Mineola, NY)
  4. Stony Brook University Hospital (Stony Brook, NY)
  5. New York Presbyterian Hospital - Weill Cornell Medical Center (New York, NY)
  6. North Shore University Hospital (Manhasset, NY)

And national data on:

  1. Case Mix Level
  2. Total Discharges Jan 2013 to Dec 2017
  3. Total Discharges After Exclusion
  4. Avg. Length of Stay
  5. Geometric Mean Length of Stay
  6. All Cause Readmission Rate (%)
  7. Unplanned Readmission Rate (%)
  8. Total Medicare Payments
  9. Payment per Day
  10. Payment per Discharge
  11. Total Medicare Charges
  12. Avg. Charges
  13. Mortality Rate (%)
  14. SNF Discharge Rate (%)
  15. Home Discharge Rate (%)


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James Pitt

James Pitt is a science writer with experience in medical devices and textbook publishing. His hobbies include reading, flintknapping, and squinting at RStudio. He received a bachelor's in Human Evolutionary Biology from Harvard.