Abstract WMP38: One Year Medicare Spending On Beneficiaries In Atrial Fibrillation Not Being Treating With Long-term Anticoagulants Experiencing A Hospitalization For Ischemic Stroke

Abstract

Background: It is well known that individuals in atrial fibrillation (AF) who are not using anticoagulants are at higher risk of Ischemic Stroke (IS). These hospitalizations result in the utilization of significant healthcare resources in addition to reducing patients’ quality of life. The purpose of this study is to estimate how much the Medicare program spends treating a Medicare beneficiary (MB) with AF who are not being anticoagulated with an IS hospitalization and the 12-months following discharge. Method: The study population consisted of all MBs in the fee-for-service program who had a hospitalization for IS and were discharged between January 1, 2018 to December 31, 2018. A total of 50,509 MBs met the study inclusion criteria and were not excluded due to prior history of stroke or on long-term anticoagulants. The study period for accumulating Medicare spending at healthcare facilities is for the index hospitalization and all facility claims that occurred within 12-months of the index hospital discharge date. Results: Average total Medicare spending per MB for the study population was $46,867±$49,212 resulting in total Medicare spending of nearly $2.5 billion during the study period. Highest average spending per MB was for hospital services $25,848 (of which $15,790± $20,984 occurred during the index hospitalization and $10,058±$21,956 during readmission during the follow-up period. The Medicare program also spent over $3,000 per study patient at skilled nursing facilities ($8,131±$14,979), rehabilitation facilities ($5,538±$12,739), and outpatient facilities or emergency departments ($3,056±$7,495). At least, 19% of MB died during the study period. Medicare spent $25,397±$30,259 on those MBs that died during their index hospitalization and $67,276±$65,021 on those MBs that survived their index IS hospitalization but died during the follow-up period. Conclusion: MBs with AF who are not being treated with anticoagulants and suffer an ischemic stroke result in one-year Medicare Part A program spending of approximately $47,000 per person compared to the average Medicare spending for all services of approximately $12,000 per beneficiary in 2018. Identification of MB in AF and treatment with anticoagulants would save CMS significant dollars.