title: Procedure intensity and the cost of care.
abstract: BACKGROUND
  The intensive practice style of hospitals with high procedure rates may result in higher costs of care for medically managed patients. We sought to determine how costs for patients with heart failure (HF) not receiving procedures compare between hospital groups defined by their overall use of procedures.
  
  
  RESULTS
  We identified all 2009 to 2010 adult HF hospitalizations in hospitals capable of performing invasive procedures that had at least 25 HF hospitalizations in the Perspective database from Premier, Inc. We divided hospitals into 2 groups by the proportion of patients with HF receiving invasive percutaneous or surgical procedures: low (>0%-10%) and high (≥ 10%). The standard costs of hospitalizations at each hospital were risk adjusted using patient demographics and comorbidities. We used the Wilcoxon rank sum test to assess cost, length of stay, and mortality outcome differences between the 2 groups. Median risk-standardized costs among low-procedural HF hospitalizations were $5259 (interquartile range, $4683-$6814) versus $6965 (interquartile range, $5981-$8235) for hospitals with high procedure use (P<0.001). Median length of stay was 4 days for both groups. Risk-standardized mortality rates were 5.4% (low procedure) and 5.0% (high procedure) (P=0.009). We did not identify any single service area that explained the difference in costs between hospital groups, but these hospitals had higher costs for most service areas.
  
  
  CONCLUSIONS
  Among patients who do not receive invasive procedures, the cost of HF hospitalization is higher in more procedure-intense hospitals compared with hospitals that perform fewer procedures.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Serene I
authors.initials: SI
authors.lastname: Chen
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.forename: Nancy
authors.initials: N
authors.lastname: Kim
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Strait
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Li
authors.forename: Kyan C
authors.initials: KC
authors.lastname: Safavi
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D006742:Hospital Bed Capacity / Q000191:economics; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006780:Hospitals, Rural / Q000191:economics; D006784:Hospitals, Teaching / Q000191:economics; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult