30-Day Medicare Spending for Acute Myocardial Infarction Varies Widely

An investigation into 30-day Medicare spending among patients hospitalized with acute myocardial infarction (AMI) found that spending varies across hospitals.

“There is increasing policy focus on reducing costs of care for AMI,” Rishi K Wadhera, MD, MPhil, a cardiology fellow at the Brigham and Women’s Hospital, and colleagues wrote. “However, the degree to which hospital-level variation in 30-day spending during and immediately following an AMI hospitalization influences outcomes is unknown. We sought to investigate variation in hospital-level 30-day AMI spending and its association with patient outcomes.”

The researchers studied 642,105 hospitalizations of Medicare patients aged 65 years and older with AMI at 2319 acute-care hospitals. Eligible study data included fee-for-service payments associated with 30-day episodes of care for AMI. They mainly measured for mortality within 30 days of admission.

Study results showed that hospitals that spent more for 30-day AMI episodes were larger, teaching hospitals, located in urban areas, had cardiac catheterization laboratories and cardiac surgery capability, and had higher rates of coronary revascularization.

The researchers also found that higher spending is associated with lower 30-day mortality among patients with AMI. 

“Thirty-day Medicare spending for an episode of AMI care varies significantly across hospitals,” Dr Wadhera and colleagues concluded. “Higher 30-day hospital spending is associated with lower odds of 30-day mortality
among beneficiaries. Further investigation is needed to understand the mechanisms that mediate this relationship.”

—David Costill