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. 2019 Mar 25;19(1):190.
doi: 10.1186/s12913-019-4018-0.

Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study

Sudhakar V Nuti  1   2 , Shu-Xia Li  2 , Xiao Xu  2   3 , Lesli S Ott  2   4 , Tara Lagu  5   6 , Nihar R Desai  2   7 , Karthik Murugiah  2   7 , Michael Duan  8 , John Martin  8 , Nancy Kim  9 , Harlan M Krumholz  10   11   12
Affiliations

Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study

Sudhakar V Nuti et al. BMC Health Serv Res. .

Abstract

Background: Efforts to decrease hospitalization costs could increase post-acute care costs. This effect could undermine initiatives to reduce overall episode costs and have implications for the design of health care under alternative payment models.

Methods: Among Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with acute myocardial infarction (AMI) between July 2010 and June 2013 in the Premier Healthcare Database, we studied the association of in-hospital and post-acute care resource utilization and outcomes by in-hospital cost tertiles.

Results: Among patients with AMI at 326 hospitals, the median (range) of each hospital's mean per-patient in-hospital risk-standardized cost (RSC) for the low, medium, and high cost tertiles were $16,257 ($13,097-$17,648), $18,544 ($17,663-$19,875), and $21,831 ($19,923-$31,296), respectively. There was no difference in the median (IQR) of risk-standardized post-acute payments across cost-tertiles: $5014 (4295-6051), $4980 (4349-5931) and $4922 (4056-5457) for the low (n = 90), medium (n = 98), and high (n = 86) in-hospital RSC tertiles (p = 0.21), respectively. In-hospital and 30-day mortality rates did not differ significantly across the in-hospital RSC tertiles; however, 30-day readmission rates were higher at hospitals with higher in-hospital RSCs: median = 17.5, 17.8, and 18.0% at low, medium, and high in-hospital RSC tertiles, respectively (p = 0.005 for test of trend across tertiles).

Conclusions: In our study of patients hospitalized with AMI, greater resource utilization during the hospitalization was not associated with meaningful differences in costs or mortality during the post-acute period. These findings suggest that it may be possible for higher cost hospitals to improve efficiency in care without increasing post-acute care utilization or worsening outcomes.

Keywords: Bundled payments; Costs; Health policy; Medicare; Post-acute.

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Conflict of interest statement

Ethics approval and consent to participate

The study was conducted under a collaborative contract with Premier, Inc. regarding protection of privacy of hospitals and other providers, which permits the linking of hospital data. For use of Premier data, the Yale University Human Investigation Committee exempted this study protocol as defined by the Office of Human Research Protections because data was de-identified. For CMS data, institutional review board approval, including waiver of the requirement of participant informed consent, was provided by the Yale University Human Investigation Committee.

Consent for publication

Not applicable.

Competing interests

Dr. Krumholz is a recipient of research agreements from Medtronic and Johnson & Johnson (Janssen), through Yale, to develop methods of clinical trial data sharing; was the recipient of a grant from Medtronic and the Food and Drug Administration, through Yale, to develop methods for post-market surveillance of medical devices; received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to the Cook IVC filter litigation; chairs a cardiac scientific advisory board for UnitedHealth; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Boards for Element Science and for Facebook, and the Physician Advisory Board for Aetna; and is the founder of Hugo, a personal health information platform. Drs. Krumholz, Li, Xu, and Desai work under contract to the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are publicly reported. Dr. Lagu has received consulting fees from the Institute for Healthcare Improvement for her input on a project to help health systems achieve disability competence. The other authors do not have disclosures to report.

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Figures

Fig. 1
Fig. 1
a and b. Resource Utilization by In-Hospital Cost Tertiles. a Relative Contribution of Service Categories to In-Hospital Costs by Hospitals in Different In-Hospital Cost Tertiles. Green bars indicate the low in-hospital cost tertile, blue bars the medium in-hospital cost tertile, and red bars the high in-hospital cost tertile. ICU: intensive care unit; CCU: coronary care unit; OR: operating room. b Relative Contribution of Service Categories to Post-Acute Payments by Hospitals in Different In-Hospital Cost Tertiles. Green bars indicate the low in-hospital cost tertile, blue bars the medium in-hospital cost tertile, and red bars the high in-hospital cost tertile
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