The CCSIP reporting website was updated through 2014, now including a breakdown of aortic valve replacement procedures between transcatheter AVR (TAVR) and surgical AVR (SAVR). At several sites where significant volumes of TAVR are being performed, SAVR volumes have decreased. For example, at Cedars Sinai Medical Center, SAVR has decreased by 50%:
Statewide, TAVR represented 30% of all isolated AVRs during 2013-2014. However, overall, isolated SAVR volume has not yet been affected; 7074 AVRs were performed in 2011-2012 and 7022 in 2013-2014. Further details about CABG, PCI and Heart valve volumes and outcomes are available at the CCSIP reporting website.
Cardiothoracic surgeons in California are at a crossroads with regard to public reporting in cardiac surgery. The Clinical Advisory Panel of the California CABG Outcomes Reporting Program (CCORP) recommended in 2013 that no additional surgical procedures be added to the report without including percutaneous interventions, such as PCI. However, the new panel voted last year to include CABG-valve procedures as part of the mandate to report on “all” CABG surgery. A risk model was approved at the February CCORP meeting.
Reporting CABG-valve without reporting other valve procedures will be problematic for several reasons. Risk adjustment will be less reliable in view of the lower case volumes combined with wide variation in patient risk factors. Statistical significance will be rare because most hospitals have low volume. Unintended consequences might include a tendency to omit adding CABG to a valve procedure to avoid inclusion in the report, or avoiding high risk cases and recommending PCI or medical treatment instead of surgery.
The CASTS successfully lobbied for assistant fees last year, but attempts to expand public reporting to PCI failed in the legislature due to budget concerns. We have updated the CASTS reporting program, the California Cardiac Surgery and Intervention Project (CCSIP), through 2013. A 2014 update is scheduled this summer. The website (www.californiacardiacsurgery.com/CCSIP2013) shows hospital procedure volumes for CABG, PCI and all cardiac surgical procedures. A participation fee is required to access outcome data for isolated CABG, PCI, CABG-valve and isolated valve procedures. We strongly recommend that cardiac surgical programs make use of this important resource to follow their comparative outcomes and see how a future report might look.
We need your input. Please click on the comment balloon above and post your comments. We will carry your responses to the CCORP Clinical Advisory Panel, to OSHPD and any other appropriate stakeholders.
At its annual meeting on June 28, 2014 CASTS board members and representatives from the data managers group discussed changes that would allow STS/ACC data abstractors and their quality administrators access to CASTS membership. Scott Kronenberg agreed to prepare a bullet list of action items that would accomplish the mutual goals of surgical teams and hospital quality personnel. The CASTS urges everyone involved in data collection and quality management to be involved in the discussion. We would greatly appreciate your comments!
At its annual meeting on June 28, 2014 CASTS board members and representatives from the data managers group discussed changes that would allow STS/ACC data abstractors and their quality administrators access to CASTS membership. Scott Kronenberg agreed to prepare a bullet list of action items that would accomplish the mutual goals of surgical teams and hospital quality personnel. The CASTS urges everyone involved in data collection and quality management to be involved in the discussion. Please review the proposal prepared by Scott and post your comments here!
James MacMillan attended a hearing in Sacramento last week at which Senate Bill 830 was presented and discussed. Dr. MacMillan submitted a letter of support and made a presentation to the committee hearing. He described the changes that have occurred in cardiovascular procedures since the beginning of public reporting of CABG more than ten years ago. The incidence of CABG has decreased, and there are now 4 times more PCI’s than CABG procedures performed in California. Heart Valve procedures have increased relative to CABG, now representing more that half of the cardiac surgeres performed at most hospitals. Outcomes for CABG and valve surgery have improved, and recent data shows that PCI accounts for more deaths and complications than cardiac surgery. His presentation was well received and there appears to be little opposition to the expansion of public reporting.
The CASTS reporting website has been completely revised and updated. The California Cardiac Surgery and Intervention Project (CCSIP) collects data annually from the OSHPD Patient Discharge Database and reports hospital-specific outcomes on CABG, Valve, and PCI procedures. In-hospital and 90-day post hospital mortality and adverse events are reported. The current revision is intended to provide notice to California heart programs in advance to public reporting that will follow passage of SB 830. Cardiac surgeons and heart teams may gain access to the new data by registering at the CASTS login page. The reporting website is also linked from the CASTS home page.
CASTS board members had an informal luncheon meeting at the STS in Orlando. The primary topic of conversation was related to the update of the mandatory public reporting law SB 680. The update, known as SB 830, is in draft form and currently being prepared by James MacMillan of CASTS and Bill Bommer of CAACC. The legislation will allow reporting of PCI and Valve outcomes beginning in 2015. CASTS is also preparing an update to its reporting site www.californiacardiacsurgery.com which will provide an examples of information that may be presented in future public reports. The new reports are designed similar to those in New York, which provide aggregated isolated valve and valve-CABG groups as well as CABG and PCI. The reports will be available at the end of March to qualified users.
We had a very productive meeting today with Senator Galgiani and her chief of staff, Ross Warren. Nilas Young, Chief of Cardiac Surgery at Davis Medical School, Junaid Khan, President of CASTS, Bill Bommer, Professor of Cardiology at Davis, and James Macmillan were present. They have submitted a spot bill which is quite good, but needs some additions which they invited us to submit. We all agreed on the strategy of portraying this effort as an update to SB 680 to account for changes in practice patterns and new procedures, ie PCI reporting.
James MacMillan is planning a meeting with CA State Senator Cathleen Galgiani next month in Sacramento. She has agreed to sponsor the amendments to SB 680. We also have contacted Elizabeth (Betsy) Imholz, who is head of the west coast health team for the Consumers Union. Betsy was part of the group that sponsored the original bill in 2001. She indicated that the bill mandated OSHPD to report on all surgical and obstetrical procedures and that she was surprised that this hadn’t happened. CU will help with an update to make more reports available to the public. CASTS and CAACC will be soliciting ideas from members about the reporting process.
The CASTS Board of Directors met at the California ACC Awards Dinner in Beverly Hills on November 22. Discussion topics included physician-hospital affiliation structures, public reporting of PCI and valve procedures, and regional initiatives for data sharing. Dr. MacMillan reported that he has been in contact with Cathleen Galgiani, state senator from his district, who is interested in sponsoring legislation to update SB 680, the mandatory reporting law. Bill Bommer, immediate past president of CAACC, and Joe Parker, head of the Healthcare Outcomes Center at OSHPD, will also participate in the process. A meeting will be held in Sacramento in the near future.
Dr. Caffarelli will produce a report on the various options available for physician-hospital affiliation. Dr. Kamlot will report back about data sharing and quality improvement efforts with CA data managers. Minutes of the meeting are attached below.
CASTS Board Meeting 11222013