Elsevier

Healthcare

Volume 2, Issue 3, September 2014, Pages 196-200
Healthcare

Assessing variation in utilization for acute myocardial infarction in New York State

https://doi.org/10.1016/j.hjdsi.2014.05.001Get rights and content

Abstract

Background

Wide variations exist in healthcare expenditures, though most prior studies have assessed aggregate utilization. We sought to examine healthcare utilization variation in New York State by assessing hospitals in peer groups of similar capabilities.

Methods

Using charge data in New York State from the 2008 Statewide Planning and Research Cooperative System (SPARCS) and cost-to-charge ratios at the cost-center level drawn from Institutional Cost Reports, we calculated total, routine, and ancillary costs for patients discharged with an acute myocardial infarction (AMI) diagnosis in 2008. We assessed the correlation of these cost data to Hospital Referral Region (HRR) Medicare reimbursement data from the 2007 Dartmouth Atlas of Health Care. After describing hospital level cost variability, we examined characteristics associated with higher costs within peer groups of similar cardiac care capabilities.

Results

We found greater costs in hospitals providing the highest level of cardiovascular services, with cardiac surgery capable hospitals and non-invasive hospitals having total costs of $21,166 and $9268 per AMI discharge, and ancillary costs of $12,006 and $4167 per AMI discharge, respectively. Substantial variability in utilization existed in all levels of hospitals and across individual departmental cost centers. The two factors most frequently associated with higher total and ancillary costs across peer groups were patient case mix index and major or minor teaching status.

Conclusions

Significant variation in cost per AMI discharge exists even within peer groups of hospitals with similar cardiac care capabilities.

Implications

These findings support measurement and analysis at the hospital level to further understand the reasons for variation in utilization.

Introduction

In the quest to control healthcare costs, the ultimate goal is to provide the information and environment that facilitates value-based care at the local level. Studies examining healthcare utilization have demonstrated wide variations at the regional level.1, 2, 3 While most prior studies have examined Medicare reimbursements, such analyses were made problematic by the inclusion of “public policy payments” – disproportionate share, graduate medical education, and outlier payments. By performing our analysis using SPARCS cost data, which do not include public policy payments, we are able to examine the utilization directly associated with AMI admissions. In order to support the use of hospital cost data for this purpose and to relate our findings to the question of regional variations in care, we sought first to assess whether hospital costs correlated with Medicare reimbursements, both at the regional level. Then we sought to describe the distribution of these costs at the department level within hospital peer-group categories. Lastly, we examined whether any correlation existed between the costs per discharge and hospital characteristics for AMI patients.

Section snippets

Materials and methods

We analyzed hospital discharges for AMI in New York State in 2008 in the SPARCS database4 that contains patient level data on demographics, diagnoses, procedures, days of care, and charges for every hospital discharge, ambulatory surgery patient and emergency discharge admission in New York State. The reasons for specifically studying AMI were that clear treatment guidelines exist, it is a common hospital admission, the costs are distributed across multiple departments (cost centers), and

Results

We analyzed data that represented 56,000 AMI cases in 150 hospitals. We found a strong correlation (R2 0.74) between the average Medicare inpatient sector reimbursements per enrollee and the total costs per AMI discharge using SPARCS data for all hospitals within each HRR (Fig. 1). The patient and hospital characteristics of each peer group are listed in Table 1. In examining the individual costs by hospitals׳ cardiac care capability, the average total costs per AMI discharge were higher for

Discussion

With much of the prior research examining utilization variations at the HRR level, such analyses do not provide sufficient granularity to understand differences in practice at an individual hospital level. As the United States struggles with growing health care costs and considers strategies to control those costs, questions about the factors related to cost variation are paramount. We sought to shed light on such questions by first determining whether such an analysis of variations in costs at

Funding

This work was supported through a grant from the New York State Health Foundation (Grant ID#3426591). Dr. Borden was supported at the Weill Cornell Medical College as a Nanette Laitman Clinical Scholar in Public Health.

Disclosures

Dr. Borden also serves as a medical officer at the Agency for Healthcare Research and Quality (AHRQ), although his work on this study was not related to AHRQ and the views expressed are his own.

Acknowledgments

Portions of these findings were presented in Atlanta, GA on May 10, 2012 at The American Heart Association 13th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, and were presented in an April 2011 New York State Health Foundation report entitled “Beyond the Dartmouth Atlas of Health Care: Exploring Variations in Inpatient Hospital Costs in New York State—the Cases of Acute Myocardial Infarction (AMI) and Congestive Heart Failure (CHF).”

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Cited by (0)

This research was supported by the New York State Health Foundation. The views expressed in this manuscript represent those of the authors, and do not necessarily represent the official views of the New York State Health Foundation.

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