Abstract 15007: Association Of Dual Eligibility For Medicare And Medicaid With Heart Failure Quality And Outcomes Among Gwtg-hf Hospitals

Abstract

Introduction: The Centers for Medicare & Medicaid Services (CMS) is using a new peer group-based payment system to compare hospital performance which classifies hospitals into quintiles based on their share of dual eligible beneficiaries for Medicare and Medicaid. This study evaluated the association of percent dual eligibility for Medicare Medicaid with HF quality of care and outcomes. Methods: This is a retrospective analysis of patients hospitalized for HF using the Get With The Guidelines-HF (GWTG-HF) registry between July, 1 2010 - December 31, 2017. Study endpoints included HF process of care measures, in-hospital mortality, 30-day all-cause or HF readmissions, 30-day all-cause mortality. We included patients aged ≥65 years old with available data on dual eligibility status. Hospitals were divided into quintiles based on their share dual eligible patients. Quality and outcomes were analyzed using unadjusted and adjusted multivariable logistic regression models. Results: A total of 258,995 HF hospitalizations from 455 sites were included in the primary analysis of the study. Hospitals in the highest dual eligibility quintile (Q5) tended to care for patients who were younger, more likely female, belong to racial minority groups, or located in rural areas compared with Q1 sites. After multivariable adjustment, hospitals with the highest quintile of dual eligibility (Q5 sites) were associated with lower rates of key process measures including evidence-based beta blocker prescription (aOR: 0.70, 95% CI [0.52,0.94]), measure of left ventricular function (aOR: 0.39, 95% CI [0.21,0.72]), anticoagulation for atrial fibrillation or atrial flutter (aOR: 0.68, 95% CI [0.51,0.91]). Differences in clinical outcomes were seen with higher 30-day all-cause (aOR: 1.24, 95% CI [1.14,1.35]) and HF (aOR: 1.14, 95% CI [1.03,1.27]) readmissions in higher dual eligible Q5 sites compared to Q1 sites. Risk-adjusted in-hospital and 30-day mortality did not significantly differ in Q1 vs Q5 hospitals. Conclusions: Higher dual eligibility quintile sites were associated with lower rates of key HF quality of care process measures and higher 30-day all-cause or HF readmissions compared to lower dual eligibility quintile sites.