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It’s time for mitral valve surgery, but which hospital will you choose?

When weighing options, close to home isn't always best choice

women and doc blogOnce a decision is made to have heart surgery, patients tend to favor staying close to home.

But researchers at the University of Michigan analyzed mitral valve surgery to see if patients benefit from going to a center of excellence hospital—one that specializes in the procedure and sees a high volume of patients —as opposed to a nearby community hospital.

They found that going to a center of excellence is the better option for both patients and insurers, even if it’s farther away from the patient and costs more upfront.

Frank Fazzalari, M.D., professor of cardiac surgery, working with experts at the U-M Ross School of Business and cardiac surgeon Steve Bolling, M.D., inspired the look at how decisions are made about heart surgery.

“One of the big questions for patients and insurers right now is which procedures should be done in specialized places and which procedures should be done in community hospitals,” says Wally Hopp, professor at the Ross School of Business. “The decision tree is often a mess, and the resulting decisions often don’t make sense from a health standpoint or cost standpoint. The key to unlocking the puzzle is good information.”

Knowing the signs to look for

A typical patient with mitral valve disease has been under a doctor’s care for a while, watching for changes that mean surgery is needed to fix their heart valves.

The mitral valve controls the flow of blood going in one direction from the lungs to the body.

Indications of the need for surgery include a murmur that has gotten louder or valve backflow, called regurgitation, that worsens, says Bolling, professor of cardiac surgery and director of the U-M Mitral Valve Clinic, one of the largest mitral valve programs in the country.

The research team mined troves of data from the state of New York on cardiac patients and their outcomes.

When data is the best medicine

Among their findings: More surgeries at centers of excellence resulted in a mitral valve repair—which is trickier to perform but has fewer complications—as opposed to a valve replacement, which leads to more complications and often requires ongoing medication.

Patients treated at a center of excellence had longer life expectancy and fewer complications. Their insurers saved $471 to $7,978 over the long term, depending on the age and health of the person.

The problem is that only about 40 percent of patients chose a center of excellence for mitral valve surgery, despite clear evidence of better outcomes and available capacity. That goes down to 30 percent when patients have to travel only an additional five miles. It’s a case where the patient’s best option is also the most cost-effective, but the message hasn’t gotten through.

“People’s choices seem to be influenced by how close people are to a center of excellence, if they’ve been there before, or if the hospital advertises,” says Jun Li, assistant professor of technology and operations at Ross. “One of our goals is to get better information to people and look for better options.”

Continue reading about mitral valve repair:


 

Frankel-informal-vertical-sigThe University of Michigan Samuel and Jean Frankel Cardiovascular Center is the top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at umcvc.org.