Association Between Medicare Expenditures and Adverse Events for Patients With Acute Myocardial Infarction, Heart Failure, or Pneumonia in the United States

Abstract

IMPORTANCE Studies have shown that adverse events are associated with increasing inpatient care expenditures, but contemporary data on the association between expenditures and adverse events beyond inpatient care are limited. OBJECTIVE To evaluate whether hospital-specific adverse event rates are associated with hospitalspecific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the 2011 to 2016 hospitalspecific risk-standardized 30-day episode-of-care expenditure data from the Centers for Medicare & Medicaid Services and medical record-abstracted in-hospital adverse event data from the Medicare Patient Safety Monitoring System. The setting was acute care hospitals treating at least 25 Medicare fee-for-service patients for AMI, HF, or pneumonia in the United States. Participants were Medicare fee-for-service patients 65 years or older hospitalized for AMI, HF, or pneumonia included in the Medicare Patient Safety Monitoring System in 2011 to 2016. The dates of analysis were July 16, 2017, to May 21, 2018. MAIN OUTCOMES AND MEASURES Hospitals' risk-standardized 30-day episode-of-care expenditures and the rate of occurrence of adverse events for which patients were at risk. RESULTS The final study sample from 2194 unique hospitals included 44 807 patients (26.1% AMI, 35.6% HF, and 38.3% pneumonia) with a mean (SD) age of 79.4 (8.6) years, and 52.0% were women.

Analysis of Hospital-Level Readmission Rates and Variation in Adverse Events Among Patients With Pneumonia in the United States

“…For example, it is known that hospitalized patients who experience safety-related adverse events are at greater risk of readmission. 7 , 8 , 9 , 10 What is not known is whether the CMS readmission measure conveys information about a hospital’s safety. Specifically, do patients admitted to hospitals with a higher risk-standardized 30-day all-cause readmission rate have a higher risk of a safety event while hospitalized?…”

“…For example, it is known that hospitalized patients who experience safety-related adverse events are at greater risk of readmission. [7][8][9][10] What is not known is whether the CMS readmission measure conveys information about a hospital's safety.…”

Implications of Payment for Acute Myocardial Infarctions as a 90-Day Bundled Single Episode of Care: A Cost of Illness Analysis

“…Of the 805,000 AMIs that occur in the United States per year, it is estimated that a quarter are recurrent, with recurrent AMIs associated with a twofold increase in 5-year mortality versus index AMIs [ 1 , 7 ]. Costs associated with CV-related hospitalizations have been found to be $20,000 higher than non-CV related hospitalizations (all costs reported in this article are in US dollars) [ 8 ], and Medicare expenditures for AMI in the 30-day period have been found to be higher than for other CV-related conditions such as heart failure [ 9 ]. Moreover, there is growing evidence that readmission burden for AMI extends beyond the typical 30-day period [ 9 , 10 ].…”

“…Costs associated with CV-related hospitalizations have been found to be $20,000 higher than non-CV related hospitalizations (all costs reported in this article are in US dollars) [ 8 ], and Medicare expenditures for AMI in the 30-day period have been found to be higher than for other CV-related conditions such as heart failure [ 9 ]. Moreover, there is growing evidence that readmission burden for AMI extends beyond the typical 30-day period [ 9 , 10 ]. A recent study found that approximately a quarter of AMI episodes in the USA are associated with readmission within 90 days, an increase of approximately 65% on the proportion readmitted within 30 days [ 11 ].…”

A Comparison of Estimated Cost Savings from Potential Reductions in Hospital-Acquired Conditions to Levied Penalties Under the CMS Hospital-Acquired Condition Reduction Program

“…Recent literature estimating incremental 30-day Medicare expenditures associated with any of the 21 adverse events captured by the MPSMS yielded estimates similar to ours. 21 However, the MPSMS does not contain data on all of the same HACs as the PSI 90 score and contains data on adverse events other than HACs, making direct cost and spending comparisons difficult. 18 Our finding that most HACs were associated with significant reductions in hospital outpatient care spending is also consistent with the literature.…”