Author + information
- Received October 3, 2017
- Revision received November 22, 2017
- Accepted November 26, 2017
- Published online April 30, 2018.
- Rishi K. Wadhera, MD, MPhila,b,
- Karen E. Joynt Maddox, MD, MPHc,
- Yun Wang, PhDb,d,
- Changyu Shen, PhDb and
- Robert W. Yeh, MD, MScb,∗ ()
- aBrigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
- bRichard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, Massachusetts
- cWashington University School of Medicine, Saint Louis, Missouri
- dDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Robert W. Yeh, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, Massachusetts 02215.
Objectives The purpose of this study was to examine the association of 30-day payments for an episode of heart failure (HF) care at the hospital level with patient outcomes.
Background There is increased focus among policymakers on improving value for HF care, given its rising prevalence and associated financial burden in the United States; however, little is known about the relationship between payments and mortality for a 30-day episode of HF care.
Methods Using Medicare claims data for all fee-for-service beneficiaries hospitalized for HF between July 1, 2011, and June 30, 2014, we examined the association between 30-day Medicare payments at the hospital level (beginning with a hospital admission for HF and across multiple settings following discharge) and patient 30-day mortality using mixed-effect logistic regression models.
Results We included 1,343,792 patients hospitalized for HF across 2,948 hospitals. Mean hospital-level 30-day Medicare payments per beneficiary were $15,423 ± $1,523. Overall observed mortality in the cohort was 11.3%. Higher hospital-level 30-day payments were associated with lower patient mortality after adjustment for patient characteristics (odds ratio per $1,000 increase in payments: 0.961; 95% confidence interval [CI]: 0.954 to 0.967). This relationship was slightly attenuated after accounting for hospital characteristics and HF volume, but remained significant (odds ratio per $1,000 increase: 0.968; 95% CI: 0.962 to 0.975). Additional adjustment for potential mediating factors, including cardiac service capability and post-acute service use, did not significantly affect the relationship.
Conclusions Higher hospital-level 30-day episode payments were associated with lower patient mortality following a hospitalization for HF. This has implications for policies that incentivize reduction in payments without considering value. Further investigation is needed to understand the mechanisms that underlie this relationship.
Dr. Wadhera is supported by National Institutes of Health Training Grant T32HL007604-32, Brigham and Women's Hospital, Division of Cardiovascular Medicine, and by the Jerome H. Grossman, MD, Fellowship in Healthcare Delivery Policy at the Harvard Kennedy School’s Healthcare Policy Program; and he previously served as a consultant for Sanofi and Regeneron. Dr. Joynt Maddox has received research support from the National Heart, Lung, and Blood Institute (K23HL109177-03); and is a former employee of the U.S. Department of Health and Human Services, where she continues work on a limited basis as a contractor. Dr. Yeh has received research support from the National Heart, Lung and Blood Institute (R01HL136708) and the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 3, 2017.
- Revision received November 22, 2017.
- Accepted November 26, 2017.
- 2018 American College of Cardiology Foundation