Docs hope to convince the CMS to spend more now and save more later
Clinicians hope the CMS will drop plans to hold providers accountable for how much it costs to care for heart attack victims based on a new study that shows higher spending lead to better health outcomes.
A March 12 study that appeared in the American Heart Association Journal found that 30-day mortality rates for acute myocardial infarction or heart attack patients were 12.8% for hospitals that spent the most on care and 13.5% that spent the least on care.
The average amount spent per beneficiary in a hospital that spent the least was just over $20,000 compared to $24,000 for higher spending hospitals.
The findings come just as the CMS wants to reduce Medicare spending on heart attack patients, which hovers around $12 billion every year. The mandatory Hospital Value-Based Purchasing Program, for example, puts a growing proportion of hospitals' revenue at risk based on performance on payment and outcome measures for a 30-day episode of acute myocardial infarction care.
Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center said he worries efforts like this could raise mortality rates for heart attack patients the way that the Hospital Readmissions Reduction program appeared to raise death rates for heart failure patients.
"The concern is some of the hospitals that are producing the best outcomes for patients are going to be severely penalized," Fonarow said.
That could make hospitals focus on costs over quality, said Dr. Ashish Jha, a professor of global health at the Harvard School of Public Health. "The CMS says we will pay you less if you spend too much because that shows inefficiency, but that policy is he opposite of improving quality."
There's some skepticism that the study itself could convince the CMS to change its course, especially since the mortality rates were only modestly different between high and low spending hospitals and the study questioned what exactly higher spending hospitals did to improve outcomes.
And there's a question of whether patients going to hospitals that spent more skew wealthier than those at the lower spending hospitals. If a hospital has more private insurance patients that are not struggling with social determinates of health such as homelessness or the inability to afford perceptions, that could also explain the lower mortality rates, said Dr. Daniel Brotman, professor of medicine at Johns Hopkins University.
A JAMA study released late last year showed more Medicare dollars spent on treating heart attack patients don't lead to better health outcomes.
The study's co-author, Dartmouth professor Jonathan Skinner said he looked at data from over a decade. The new study analyzed data over three years.
Skinner said there needs to be an arrangement between value-based and fee-for-service models.
"One would want to be sure that in pay for performance efforts, that performance, which includes quality of care, is measured to ensure that hospitals aren't scrimping on care, or gaming the system," Skinner said.
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