Abstract 18033: The Contribution of Cardiovascular Spending to Total Inpatient Spending for High-Cost Patients

Abstract

Spending in the Medicare program is concentrated among a small group of patients. As novel payment mechanisms such as bundled payments and accountable care organizations proliferate, there is increasing importance to understanding where these patients’ costs originate. Cardiovascular care is an area of focus, due to the high costs and expensive technologies used within the field. However, the contribution of cardiovascular spending to total inpatient spending for high-cost patients is unknown. We used standard 5% Medicare inpatient and outpatient files from 2009 and 2010 to evaluate the proportion of inpatient spending related to cardiovascular disease for high-cost patients (top 10% of spenders in 2010) and persistently high-cost patients (top 10% of spenders in 2009 and 2010). We classified all admissions using ICD-9 codes into clinical categories. We found that costs for cardiovascular care were highly concentrated, with 77% of cardiovascular inpatient spending from the 10% of patients in the high-cost cohort, and 25% of spending from the 3% of patients in the persistently high-cost cohort. Furthermore, cardiovascular care made up a significant proportion of total hospital spending for the high-cost cohort. Ischemic heart disease, congestive heart failure, arrhythmias, stroke and transient ischemic attack, peripheral atherosclerosis, cardiac valvular disease, and angina made up 22.6% of inpatient spending for high-cost patients and 19.7% of inpatient spending for persistently high-cost patients (Table). Projected to the national Medicare population, these admissions cost more than $10 billion in 2010. In conclusion, cardiovascular spending is highly concentrated, and cardiovascular disease comprises a large portion of inpatient spending for the most expensive Medicare patients. There is a tremendous opportunity for the cardiovascular community to target high-cost patients and pursue care redesign to lower costs for these common conditions.