Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study

Sudhakar V Nuti,Harlan M Krumholz,Xiao Xu,Karthik Murugiah,John Martin,Nihar R Desai,Michael Duan,Lesli S Ott,Tara Lagu,Nancy Kim,Shu-Xia Li

doi:10.1186/s12913-019-4018-0

Abstract

BackgroundEfforts 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.MethodsAmong 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.ResultsAmong 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).ConclusionsIn 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.

Highlights

Efforts to decrease hospitalization costs could increase post-acute care costs
We examined the association between in-hospital and post-discharge resource utilization, compared patient outcomes across hospitals stratified according to their in-hospital costs, and assessed patterns of in-hospital and post-acute resource utilization across hospitals to understand how hospitals use their resources
We examined whether patients received any interventional cardiac therapies, such as cardiac catheterization, coronary artery bypass grafting (CABG) surgery, percutaneous coronary intervention (PCI) procedures, or intra-aortic balloon pump (IABP)

Summary

Introduction

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. Prior studies on episodes of care have shown that post-acute care is a substantial contributor to spending variation and could be a target for cost savings [3, 7,8,9], there have been few studies on the relationship between in-hospital and post-acute resource utilization [10] Such information would be valuable, as it is plausible that cost reductions in the hospitalization period could affect spending in the post-acute period. Knowledge about the relationship between early and late use of resources may help inform strategies to reduce resource utilization in the post-acute period while maintaining or improving health outcomes

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Discussion

Conclusion