Opening of specialty cardiac hospitals and use of coronary revascularization in medicare beneficiaries.
BACKGROUND
Although proponents argue that specialty cardiac hospitals provide high-quality cost-efficient care, strong financial incentives for physicians at these facilities could result in greater procedure utilization.


OBJECTIVE
To determine whether the opening of cardiac hospitals was associated with increasing population-based rates of coronary revascularization.


METHODS
In a study of Medicare beneficiaries from 1995 through 2003, we calculated annual population-based rates for total revascularization (coronary artery bypass graft [CABG] plus percutaneous coronary intervention [PCI]), CABG, and PCI. Hospital referral regions (HRRs) were used to categorize health care markets into those where (1) cardiac hospitals opened (n = 13), (2) new cardiac programs opened at general hospitals (n = 142), and (3) no new programs opened (n = 151).


METHODS
Rates of change in total revascularization, CABG, and PCI using multivariable linear regression models with generalized estimating equations.


RESULTS
Overall, rates of change for total revascularization were higher in HRRs after cardiac hospitals opened when compared with HRRs where new cardiac programs opened at general hospitals and HRRs with no new programs (P<.001 for both comparisons). Four years after their opening, the relative increase in adjusted rates was more than 2-fold higher in HRRs where cardiac hospitals opened (19.2% [95% confidence interval {CI}, 6.1%-32.2%], P<.001) when compared with HRRs where new cardiac programs opened at general hospitals (6.5% [95% CI, 3.2%-9.9%], P<.001) and HRRs with no new programs (7.4% [95% CI, 3.2%-11.5%], P<.001). These findings were consistent when rates for CABG and PCI were considered separately. For PCI, this growth appeared largely driven by increased utilization among patients without acute myocardial infarction (42.1% [95% CI, 21.4%-62.9%], P<.001).


CONCLUSIONS
The opening of a cardiac hospital within an HRR is associated with increasing population-based rates of coronary revascularization in Medicare beneficiaries.
Nallamothu
Brahmajee K
BK
VA Health Services Research and Development Center of Excellence, Ann Arbor, Mich, USA. bnallamo@umich.edu
Rogers
Mary A M
MA
Chernew
Michael E
ME
Krumholz
Harlan M
HM
Eagle
Kim A
KA
Birkmeyer
John D
JD
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002300:Cardiac Care Facilities / Q000191:economics / Q000600:supply & distribution*; D016507:Cardiology Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D002391:Catchment Area, Health; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000639:trends; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D016014:Linear Models; D006278:Medicare / Q000706:statistics & numerical data; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D016730:Program Development; D012052:Reimbursement, Incentive; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data*