1. Significantly lower non-urgent cardiovascular procedure rates existed among patients enrolled in a Medicare Advantage plan.
2. Geographic variations in cardiovascular procedure rates were equivalent in Medicare Advantage and Medicine Fee-for-service plans.
Evidence Rating Level: 2 (Good)
Study Rundown: As healthcare costs in the United States grow rampant and stress the economy, investigations of causes and solutions to the system’s inefficiencies have gained much attention. Since one of the largest sectors of healthcare costs in this country is due to cardiovascular disease and its related procedures, the authors of this study sought to identify differences in rates of cardiovascular procedures performed under two different Medicare reimbursement systems: Fee-for-service (FFS) and Advantage, a capitated plan. The study found that rates of angiography and percutaneous coronary intervention (PCI) were significantly lower in the Advantage versus FFS program, even when adjusted for age, sex, race and income, though regional variations in procedure rates were equivalent in both groups. These results suggest that financial/reimbursement incentives do affect patient care delivery and overall health care costs. While these results are still important, this study did not analyze for any differences in patient outcomes between the two groups. Furthermore, conclusions are based solely on cardiovascular procedures, and thus more studies on the affect of reimbursement systems on patient outcomes are also necessary.
In-Depth [cross-sectional study]: Medical records of 878,339 Medicare Advantage patients and 5,013,650 Medicare FFS patients from 32 different regions of the country (referred to as Hospital Referral Regions, HRR) were analyzed over a 5-year period (2003-2007). Patients were over 65 years of age and procedure rates were calculated as number of procedures per 1000 enrollee years. Procedures were classified as “urgent” if they were performed during an admission for acute myocardial infarction, and all others as “non-urgent.” When adjusted for age, sex, race, and income procedure rates of Advantage versus FFS were, respectively: angiography 16.5 vs 25.9, p<0.001; PCI 6.8 versus 9.8, p<0.001; CABG 3.1 versus 3.4, p=0.33. No difference was seen between Advantage and FFS urgent angiography (3.9 versus 4.3, p=0.24) or PCI (2.4 versus 2.7, p=0.16). Significant geographic variations in procedure rates were seen in both Advantage and FFS groups but were found to be similar to each other.
By Sam Moradian and Brittany Hasty
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