Findings from a study published Nov. 15 in JAMA Open Network suggest "that variation in payments to hospitals are, at least in part, associated with the hospitals and their ecosystems independently" of other social determinants (i.e. behaviors, race and ethnicity).

Harlan M. Krumholz, MD, SM, FACC, et al., looked at 1,615 Medicare beneficiaries hospitalized with heart failure (HF) and 708 beneficiaries hospitalized with pneumonia ages 65 years and older. Researchers looked at two payment measure cohorts: hospitals that were classified into payment quartiles for HF and pneumonia, and patients with two admissions for HF or pneumonia – one in a lowest-quartile hospital and one in a highest-quartile hospital more than one month apart.

Results showed that the same Medicare beneficiaries who were admitted with the same diagnosis (HF or pneumonia) to hospitals with the highest payment profiles incurred higher costs than when they were admitted to hospitals with the lowest payment profiles. Krumholz, et al. noted that the 30-day episode payment for hospitalization for the same patients at the lowest payment hospitals was $2,118 lower for HF and $2,907 lower for pneumonia than at the highest-payment hospitals, and more than half of the difference was associated with the payment during the index hospitalization for HF and pneumonia.

Results also revealed that the 30-day mortality rates for patients in low-payment hospitals vs. patients in high-payment hospitals were not significantly different for HF or pneumonia, nor were median length of stay and readmission rate. No significant difference was observed in mean days between the paired admissions among patients first admitted to the low-payment hospitals and among patients first admitted to the high-payment hospitals.

"Research is needed to identify and address cultural and financial factors in resource use that might affect these different payment profiles," Krumholz and colleagues said. "Nevertheless, the idea that lower costs are achievable may provide the impetus to investigate new strategies rather than simply resist the possibility that efficiencies can be achieved."

Keywords: ACC Advocacy, Medicare, Centers for Medicare and Medicaid Services, U.S.

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