Key result
Among Medicare beneficiaries hospitalized with acute myocardial infarction, higher in-hospital resource utilization was not associated with significant differences in 30-day risk-standardized post-acute payments ($4,922 for high vs $5,014 for low cost tertiles, p=0.21).
Why the study?
Efforts to decrease hospitalization costs could increase post-acute care costs, potentially undermining initiatives to reduce overall episode costs under alternative payment models.
Does higher in-hospital resource utilization reduce post-acute care costs or improve outcomes in Medicare beneficiaries hospitalized for acute myocardial infarction?
Cross-Sectional (n=82,008)
Yes
Does higher in-hospital resource utilization reduce post-acute care costs or improve outcomes in Medicare beneficiaries hospitalized for acute myocardial infarction?
Answers are grounded in this paper and cite their sources.
Higher in-hospital resource utilization for AMI patients is not associated with lower post-acute care costs or improved mortality, but is associated with higher 30-day readmission rates.
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.
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Nuti et al. (2019) conducted a cross-sectional in Acute myocardial infarction (n=82,008). High in-hospital resource utilization (cost tertiles) vs. Low in-hospital resource utilization was evaluated on 30-day risk-standardized post-acute payments (p=0.21). Among Medicare beneficiaries hospitalized with acute myocardial infarction, higher in-hospital resource utilization was not associated with significant differences in 30-day risk-standardized post-acute payments ($4,922 for high vs $5,014 for low cost tertiles, p=0.21).
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