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Medical payments affect heart attack outcomes

Researchers from Beth Israel Deaconess Medical Center (BIDMC) analyzed if medical payments for acute myocardial infarction affects treatment outcomes for patients. Findings of this research are published in journal Circulation.

To cut down healthcare expenditure there has been a growing trend towards providing incentives to reduce cost at the same time maintaining acceptable outcomes. Hospital Value-Based Purchasing Program administered by the Centers for Medicare and Medicaid Services (CMS) is one such effort to reduce the cost of care. This program makes payments based on quality outcome measures for conditions such as acute myocardial infarction. Hospitals that perform poorly in these measures receive a reduced payment.

Researchers used national Medicare claims data and examined more than 640,000 hospitalizations involving patients 65 years or older hospitalized for heart attack and found that higher 30-day spending to care for Medicare beneficiaries with acute myocardial infarction was associated with a modest reduction inpatient mortality.

“Recent policy efforts have focused on improving the value of care, both in terms of total spending and patient outcomes,” said corresponding senior author Robert W. Yeh, MD, MSc, Director of the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center. “We need to understand 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 whether the strong incentive to reduce hospital spending has unintended adverse consequences.”

“These findings have important implications for patient care,” said first author Rishi K. Wadhera, MD, MPhil, an investigator at the Smith Center at Beth Israel Deaconess Medical Center and a cardiology fellow at Brigham and Women’s Hospital.Wadhera. “While this study found that increased spending was associated with better outcomes, not all spending is of equal value and further research is needed to find out why higher-spending hospitals have better outcomes.”

Citation: Wadhera, Rishi K., Karen E. Joynt Maddox, Yun Wang, Changyu Shen, Deepak L. Bhatt, and Robert W. Yeh. “Association Between 30-Day Episode Payments and Acute Myocardial Infarction Outcomes Among Medicare Beneficiaries.” Circulation: Cardiovascular Quality and Outcomes 11, no. 3 (2018). doi:10.1161/circoutcomes.117.004397.

Research funding: National Institute of Health

Adapted from press release by Beth Israel Deaconess Medical Center.

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