Increased Hospital Spending After Heart Attack Linked To Modestly Lower Mortality Interview with:
Dr. Rishi K. Wadhera MD
Clinical Fellow in Medicine
Brigham and Women’s Hospital What is the background for this study?  

Response: The Hospital Value Based Purchasing program, in which over 3,000 hospitals participate, is a Centers for Medicare and Medicaid Services (CMS) pay-for-performance program that links hospital fee per service reimbursement to performance, through measures like 30-day mortality rates after an acute myocardial infarction (a heart attack), and other measures such as average spending for an episode of care for Medicare beneficiaries. Hospitals that perform poorly on these measures are financially penalized by CMS. What are the main findings? What should readers take away from your report?

Response: Our studied evaluated whether higher 30-day spending at the hospital level for acute myocardial infarction care – beginning with initial hospital admission for acute myocardial infarction and across multiple settings after discharge – was associated with lower 30-day patient mortality among Medicare beneficiaries.

We found that higher 30-day spending was associated with a modest reduction in patient mortality. This relationship was not explained by variation among hospitals in the use of expensive, but often life-saving, invasive procedures such as percutaneous coronary intervention nor differences in the use of post-acute care services, such as skilled nursing facilities, after discharge. What recommendations do you have for future research as a result of this work? 

Response: Pay-for-Performance programs have been under fire recently given little evidence that they actually improve hospital performance. Future studies should seek to understand and monitor whether programs like the Hospital Value-Based Purchasing Program are able to globally reduce spending and improve outcomes for acute conditions like acute myocardial infarction, or other conditions targeted by the program like heart failure, or whether the strong incentive the program provides to reduce spending has unintended adverse consequences for patients. In addition, while our study found that increased spending was associated with better outcomes, not all spending is of equal value and further research is also needed to find out why higher-spending hospitals have better outcomes. 


Association Between 30-Day Episode Payments and Acute Myocardial Infarction Outcomes Among Medicare Beneficiaries
Rishi K. Wadhera, Karen E. Joynt Maddox, Yun Wang, Changyu Shen, Deepak L. Bhatt, Robert W. Yeh
Circulation: Cardiovascular Quality and Outcomes. 2018;11:e004397
Originally published March 12, 2018 

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Last Updated on March 15, 2018 by Marie Benz MD FAAD