Thirty-Day and 90-Day Episode of Care Spending Following Heart Failure Hospitalization Among Medicare Beneficiaries.
| Title: | Thirty-Day and 90-Day Episode of Care Spending Following Heart Failure Hospitalization Among Medicare Beneficiaries. |
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| Authors: | Reinhardt SW; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.W.R., K.A.A.C., T.A., N.R.D.).; Clark KAA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.W.R., K.A.A.C., T.A., N.R.D.).; Xin X; Center for Outcomes Research & Evaluation (X.X., C.S.P., T.A., N.R.D.), Yale-New Haven Hospital, New Haven' CT.; Parzynski CS; Center for Outcomes Research & Evaluation (X.X., C.S.P., T.A., N.R.D.), Yale-New Haven Hospital, New Haven' CT.; Riello Iii RJ; Department of Pharmacy (R.J.R.), Yale-New Haven Hospital, New Haven' CT.; Sarocco P; Cytokinetics, Incorporated, South San Francisco, CA (P.S.).; Ahmad T; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.W.R., K.A.A.C., T.A., N.R.D.).; Center for Outcomes Research & Evaluation (X.X., C.S.P., T.A., N.R.D.), Yale-New Haven Hospital, New Haven' CT.; Desai NR; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.W.R., K.A.A.C., T.A., N.R.D.).; Center for Outcomes Research & Evaluation (X.X., C.S.P., T.A., N.R.D.), Yale-New Haven Hospital, New Haven' CT. |
| Source: | Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2022 Jul; Vol. 15 (7), pp. e008069. Date of Electronic Publication: 2022 Jul 05. |
| Publication Type: | Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101489148 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-7705 (Electronic) Linking ISSN: 19417713 NLM ISO Abbreviation: Circ Cardiovasc Qual Outcomes Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins |
| MeSH Terms: | Heart Failure*/diagnosis ; Heart Failure*/therapy ; Renal Insufficiency, Chronic*; United States/epidemiology ; Aged ; Episode of Care ; Hospitalization ; Humans ; Medicare ; Retrospective Studies |
| Abstract: | Background: Despite growing interest in value-based models, utilization patterns and costs for heart failure (HF) admissions are not well understood. We sought to characterize Medicare spending for patients with HF for 30- and 90-day episodes of care (which include an index hospitalization and 30 or 90 days following discharge) and to describe the patterns of post-acute care spending.; Methods: Using Medicare fee-for-service administrative claims data from 2016 to 2018, we performed a retrospective analysis of patients discharged after hospitalization with primary discharge diagnoses of systolic HF, diastolic HF, hypertensive heart disease (HHD) with HF, and HHD with HF and chronic kidney disease. We analyzed coding patterns across these groups over time, median 30- and 90-day payments, and costs allocated to index hospitalization and postacute care.; Results: The study included 935 962 patients discharged following hospitalization for HF (systolic HF: 178 603; diastolic HF: 165 156; HHD with HF: 226 929; HHD with HF and chronic kidney disease: 365 274). The proportion of HHD codes increased from 26% of HF hospitalizations in 2016 to 91% in 2018. There was substantial spending on 30-day (median $13 330, interquartile range $9912-$22 489) and 90-day episodes (median $21 658, interquartile range $12 423-$37 630) for HF with significant variation, such that the third quartile of patients incurred costs 3 times the amount of the first quartile. Across all codes, the index hospitalization accounted for ≈70% of 30-day and 45% of 90-day spending. Sixty-one percent of postacute care spending occurred 31 to 90 days following discharge, with readmissions and observation stays (36%) and skilled nursing facilities (27%) comprising the largest categories.; Conclusions: This patient episode-level analysis of contemporary Medicare beneficiaries is the first to examine 90-day spending, which will become an increasingly important pasyment benchmark with the expansion of the Medicare Bundled Payments for Care Improvement Program. Further investigation into the drivers of costs will be essential to provide high-value HF care. |
| Contributed Indexing: | Keywords: episode of care; heart failure; hospitalization; medicare |
| Entry Date(s): | Date Created: 20220721 Date Completed: 20220725 Latest Revision: 20250728 |
| Update Code: | 20260130 |
| DOI: | 10.1161/CIRCOUTCOMES.121.008069 |
| PMID: | 35861780 |
| Database: | MEDLINE |
Journal Article; Research Support, Non-U.S. Gov't