Payments for acute myocardial infarction episodes-of-care initiated at hospitals with and without interventional capabilities.
BACKGROUND
It is unknown whether hospitals with percutaneous coronary intervention (PCI) capability provide costlier care than hospitals without PCI capability for patients with acute myocardial infarction. The growing number of PCI hospitals and higher rate of PCI use may result in higher costs for episodes-of-care initiated at PCI hospitals. However, higher rates of transfers and postacute care procedures may result in higher costs for episodes-of-care initiated at non-PCI hospitals.


RESULTS
We identified all 2008 acute myocardial infarction admissions among Medicare fee-for-service beneficiaries by principal discharge diagnosis and classified hospitals as PCI- or non-PCI-capable on the basis of hospitals' 2007 PCI performance. We added all payments from admission through 30 days postadmission, including payments to hospitals other than the admitting hospital. We calculated and compared risk-standardized payment for PCI and non-PCI hospitals using 2-level hierarchical generalized linear models, adjusting for patient demographics and clinical characteristics. PCI hospitals had a higher mean 30-day risk-standardized payment than non-PCI hospitals (PCI, $20 340; non-PCI, $19 713; P<0.001). Patients presenting to PCI hospitals had higher PCI rates (39.2% versus 13.2%; P<0.001) and higher coronary artery bypass graft rates (9.5% versus 4.4%; P<0.001) during index admissions, lower transfer rates (2.2% versus 25.4%; P<0.001), and lower revascularization rates within 30 days (0.15% versus 0.27%; P<0.0001) than those presenting to non-PCI hospitals.


CONCLUSIONS
Despite higher PCI and coronary artery bypass graft rates for Medicare patients initially presenting to PCI hospitals, PCI hospitals were only $627 costlier than non-PCI hospitals for the treatment of patients with acute myocardial infarction in 2008.
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Gal
G
Ben-Josef
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Lesli S
LS
Ott
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Steven B
SB
Spivack
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Changqin
C
Wang
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Joseph S
JS
Ross
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Sachin J
SJ
Shah
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Jeptha P
JP
Curtis
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Nancy
N
Kim
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.).
Harlan M
HM
Krumholz
From the Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Boston Medical Center, Boston, MA (G.B.), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (L.S.O., C.W., J.S.R., J.P.C., N.K., H.M.K., S.M.B.), Yale University School of Medicine, Section of General Internal Medicine (J.S.R., N.K., S.M.B.), Section of Cardiovascular Medicine (J.P.C., H.M.K.), Robert Wood Johnson Clinical Scholars Program (H.M.K., S.M.B., J.S.R.), New Haven, CT; University of North Carolina, Gillings School of Public Health, Department of Health Policy and Management, Chapel Hill (S.B.S.); and Department of Medicine, Massachusetts General Hospital, Boston (S.J.S.). susannah.bernheim@yale.edu.
Susannah M
SM
Bernheim
D000368:Aged; D000369:Aged, 80 and over; D018588:Fee-for-Service Plans / Q000191:economics*; D005500:Follow-Up Studies; D005102:Health Expenditures; D006761:Hospitals; D006801:Humans; D006278:Medicare / Q000191:economics*; D009203:Myocardial Infarction / Q000191:economics / Q000601:surgery*; D009204:Myocardial Revascularization / Q000191:economics; D012189:Retrospective Studies; D014481:United States
acute inferior myocardial infarction; cost and cost analysis; insurance, health reimbursement; percutaneous coronary intervention