Assessing variation in utilization for acute myocardial infarction in New York State☆
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.
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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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(2003) - Statewide Planning and Reseach Cooperative System (SPARCS). 〈http://www.health.ny.gov/statistics/sparcs〉 Accessed...
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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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