PO-03-205 ARRHYTHMIA BURDEN REVEALED BY AMBULATORY CARDIAC MONITORING IN A MEDICARE ADVANTAGE POPULATION

Abstract

Medicare Advantage plans enroll an increasing proportion of Medicare beneficiaries annually. The capitation payment model for Medicare Advantage plans is dependent on prompt and accurate coding of Hierarchical Condition Categories (HCCs) that impact risk-adjusted payments. Reporting of disease is critical for clinics to estimate expenditures of Medicare Advantage populations with significant cardiac comorbidities. To quantify arrhythmia burden and potential risk adjustment impact in a Medicare Advantage population. We reviewed ambulatory electrocardiogram (ECG) monitors of 909 patients insured under a Medicare Advantage plan across 19 states. Each patient was enrolled in 14-day electrocardiogram monitoring according to clinical indication. Specialists evaluated recorded abnormal events and provided final interpretations. Standardized specialist-derived criteria were developed to assess for atrial arrhythmias, heart block, sick sinus syndrome, supraventricular tachycardia, and ventricular arrhythmias. Each patient with atrial fibrillation, supraventricular tachycardia, or sick sinus syndrome was assigned HCC96 (Specified Heart Arrhythmias). An additional monthly Medicare payment was calculated by multiplying the HCC96 coefficient of 0.268 by $750 (the approximate monthly Medicare payment corresponding to one point in risk adjustment). The average age of the sample population was 71.2 +- 0.3 (SE) years and 65.6% of patients were female. Common indications for ambulatory cardiac monitoring included palpitations (21.8%), syncope (15.4%), concern for atrial arrhythmia (9.5%), tachycardia (6.5%), and bradycardia (5.0%). Patients wore the ECG monitor for an average of 13 days. Abnormal findings included supraventricular tachycardia (59.4%), nonsustained ventricular tachycardia (6.7%), atrial fibrillation (3.0%), second- or third-degree heart block (1.2%), and sick sinus syndrome (2.6%). A majority (61.4%) had a diagnosis that could impact risk adjustment, leading to a potential increase of $1.35 million in annual Medicare reimbursement assuming this is the first recorded diagnosis of arrhythmia. Ambulatory ECG monitors reveal a high prevalence of arrhythmias that can have a significant risk adjustment impact for Medicare Advantage capitation plans. Additional clinical correlation is necessary to confirm the expected change in annual Medicare reimbursement.