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Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study.
- Source :
-
BMC health services research [BMC Health Serv Res] 2019 Mar 25; Vol. 19 (1), pp. 190. Date of Electronic Publication: 2019 Mar 25. - Publication Year :
- 2019
-
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.<br />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.<br />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).<br />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.
- Subjects :
- Aged
Cross-Sectional Studies
Fee-for-Service Plans
Health Resources statistics & numerical data
Humans
Myocardial Infarction economics
Patient Readmission economics
Patient Readmission statistics & numerical data
United States
Economics, Hospital statistics & numerical data
Health Expenditures statistics & numerical data
Hospitalization economics
Medicare economics
Myocardial Infarction therapy
Patient Acceptance of Health Care statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1472-6963
- Volume :
- 19
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC health services research
- Publication Type :
- Academic Journal
- Accession number :
- 30909904
- Full Text :
- https://doi.org/10.1186/s12913-019-4018-0