| An article I thought was interesting so I wanted to share.
Hospitals with high use of early percutaneous coronary intervention had better mortality and higher costs, but costs were balanced by lower 180-day expenditures. Costs in medicine continue to attract considerable attention. A central issue is whether the growth in spending has yielded commensurate benefits for patients. To address this issue for the care of patients with acute myocardial infarction (AMI), investigators studied random samples of 479,893 fee-for-service Medicare beneficiaries from 1999 through 2014. The primary outcome was 180-day case fatality, and the exposure variables were price-standardized Medicare payments for the index admission and for post–index date service utilization up to 180 days afterwards. Case fatality declined from 26.9% in 1999–2000 to 21.5% in 2013–2014. The overall inflation- and risk-adjusted 180-day mean expenditures per patient grew by 13.9% from 1999–2000 to 2013–2014. The increase occurred entirely by 2008; between 2008 and 2014, expenditures declined by 0.5%. In this overall period, percutaneous coronary intervention (PCI) through 180 days increased by 48.9% and coronary-artery bypass grafting decreased by 35.3%. Hospitals that had the greatest increase in early use of PCI had lower spending for skilled nursing facilities, home health agencies, and hospice. Spending growth was largely associated with the doubling of expenditures for skilled nursing and home health. Case fatality was weakly associated with changes in spending but was strongly and inversely associated with early PCI. |
|
|
|
Leave a Reply Cancel reply
You must be logged in to post a comment.
COMMENT
This insightful economic analysis attributes improvements in AMI mortality to early PCI, with offsetting reductions in other costs. Post-acute care accounted for much of the growth in AMI expenditures without a clear mortality benefit. Interestingly, since 2008, expenditures have not grown for this patient population in fee-for-service Medicare.