Influence of Payor on Use of Invasive Cardiac Procedures and Patient Outcome After Myocardial Infarction in the United States

Abstract

Payor status is associated with the use and appropriateness of invasive cardiac procedures but not length of hospital stay after myocardial infarction. The higher in-hospital mortality in the Medicaid cohort merits further study.

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction

“…26 Thus, our study and the study by Sada et al provide consistent and compelling evidence that Medicaid patients are less likely to be treated aggressively after acute myocardial infarction. The patient sample in Sada et al's study was drawn from selected institutions providing onsite cardiac catheterization services, while we examined patients from all types of acute care hospitals.…”

“…[11][12][13]17,[25][26][27][28] To our knowledge, no previous study of process of care after acute myocardial infarction has attempted to address these multiple issues in a single comprehensive analysis. In our study, Medicaid insurance was a significant independent negative predictor of procedure use even after adjustment for relevant demographic and clinical factors and hospital characteristics.…”

“…The financial disincentives of caring for Medicaid patients are apparent and are probably worsening as government funding for health care is further reduced. Some 12,26,37,38 but not all 27,39 studies have shown that resource use declines owing to a reduction in discretionary services when constrained reimbursement or other financial disincentives are applied to the health care setting. Although such forces may be at work in the management of Medicaid patients after acute myocardial infarction, they are difficult to quantify without a validated measurement tool.…”

“…5,8,10,12,13,[17][18][19][20][21][22][23][24][25][26] Likewise, patients with Medicaid insurance who are treated for acute myocardial infarction are less likely to undergo invasive procedures than those with other forms of insurance, suggesting that they receive a different, and perhaps inferior, process of care. 26 However, the Medicaid population differs from other insurance groups in terms of age, race, and sex mix; socioeconomic status (SES); and prevalence of coexistent illnesses. 17,[25][26][27][28] In addition, Medicaid patients with cardiovascular diseases receive their care in hospitals with prevailing characteristics different from those of hospitals in other insurance groups.…”

“…17,[25][26][27][28] In addition, Medicaid patients with cardiovascular diseases receive their care in hospitals with prevailing characteristics different from those of hospitals in other insurance groups. [11][12][13]17,[26][27][28] Thus, lower rates of procedure use among Medicaid patients may be indicative of more global treatment practices or preferences determined by age, race, sex, SES, or hospital-to-hospital variation. Conversely, Medicaid insurance may be more than simply a proxy for demographic, clinical, and hospital factors, exerting its own independent influence on process of care.…”