Abstract 176: Association Between Hospital-Level Cost of Cardiovascular Care and Socioeconomic Characteristics

Abstract

Background: The socioeconomic status (SES) of a hospital’s patients is an important predictor of outcome measures. Patients with low SES may also require increased healthcare resources. The relationship between the SES of a hospital’s patient cohort and cost of care is less clear. Objective: We compared the association between the cost of acute myocardial infarction (AMI) and heart failure (HF) admissions with measures of the hospital community’s SES. Methods: We used hospitals’ average 30-day, standardized, risk-adjusted payments for Medicare patients admitted for AMI or HF from 2014-2017 from Hospital Compare. We used hospital rates of Medicare-Medicaid dual use from 2014-2017 and Medicaid and Supplemental Security Income ratios (SSI) for 2016. We also constructed hospital community SES characteristics using census data by mapping hospital Medicare patients’ ZIP codes to census ZIP data. We determined the association between cost and SES using linear regression with the cost of care as the dependent variable and standardized SES variables as independent variables. We included significant SES variable in a multivariable model to calculate the proportion of variance explained. Results: The mean hospital-level 30-day AMI cost was $23,905 (standard deviation [SD]: $1,581) among 2,281 hospitals. The mean hospital-level 30-day HF cost was $16,664 (SD $1,394) among 3,499 hospitals. Dual use rates were not significantly associated with the cost of care, but higher SSI ratio was associated with increased cost (Table 1). Hospitals with communities with higher prevalence of local poverty consistently had lower costs. Similarly, higher community median income was associated with increased costs. Non-economic markers of community disparity - limited English proficiency and low educational attainment - predicted greater cost. A model with all significant SES variables had an adjusted r 2 of 0.06 for AMI costs and 0.17 for heart failure costs. Conclusion: Cost measures may not consistently penalize hospitals that care for economically disadvantaged patients. SES characteristics appear to have a stronger association with HF costs than AMI costs. The association between disadvantaged patients and cost of care is likely impacted by care access, demand elasticity, and care quality.