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Higher spending for Medicare heart attack patients has modest effect in preventing death

The findings come as pay-for-performance programs are being scrutinized due to the absence of strong evidence that they actually improve quality.

Jeff Lagasse, Associate Editor

Sometimes you get what you pay for.

Higher 30-day spending on care for Medicare beneficiaries who recently experienced a heart attack was linked to a modest reduction in patient mortality, according to researchers at the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center.

The findings come as pay-for-performance programs, such as the hospital value-based purchasing program, are being scrutinized due to the absence of strong evidence that they actually improve care quality.

In recent years, there has been a growing emphasis on improving the value of healthcare by incentivizing reduced spending and improved outcomes. One such effort is the hospital value-based purchasing program administered by the Centers for Medicare and Medicaid Services.

The program makes payments to hospitals based on several measures, including average spending for an episode of care and mortality rates for certain conditions, such as acute myocardial infarction, or heart attack. Hospitals that perform poorly in these measures receive reduced payments.

Using national Medicare claims data, the researchers examined more than 640,000 hospitalizations involving patients 65 years or older hospitalized for heart attack at an acute care hospital between July 2011 and June 2014.

The authors cautioned that the findings are preliminary. The goal was to examine recent policy efforts that have focused on improving the value of care, both in terms of dollars spent and patient outcomes. While the results indicate that programs such as the hospital value-based purchasing program may reduce costs but have unintended consequences, the authors stressed more research is needed to figure out why higher-spending hospitals have better outcomes.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com