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The Centers for Medicare and Medicaid Services (CMS) Value Based Purchasing Initiative ties hospital reimbursement to quality metric Results. We examined the relationship between performance on cardiac quality indicators and the proportion of low-income patients treated.
Data were hospital-level information on performance reported to CMS from October 2010 through September 2011 for cardiology-related process measures (90 minute door to balloon time for ST-elevation myocardial infarction (STEMI), fibrinolysis within 30 minutes of arrival for STEMI, and discharge instructions for congestive heart failure (CHF) patients) and from July 2008 through June 2011 for outcome measures (acute myocardial infarction (MI) mortality, CHF mortality). The CMS disproportionate patient percentage (DPP) quantifies the proportion of both elderly and non-elderly low-income patients at individual hospitals. We divided hospitals into quintiles based on DPP, and compared quality measure performance across these groups.
Data comprised 3501 hospitals. Hospitals treating fewer low-income patients performed better on STEMI door to balloon times (p < .001) and provision of CHF-specific discharge instructions (p < .01). These differences were driven by significantly worse performance in hospitals treating the most low-income patients (55%). Other quintiles of DPP did not vary significantly in performance. Mean compliance with the 90 minute STEMI door to balloon time varied from 89.5% to 94.3%. MI and CHF mortality were statistically, but not clinically different across quintiles. Delivery of fibrinolysis within 30 minutes did not vary by DPP.
Cardiology-related quality measure performance varies across hospitals based on proportion of low-income patients. These results suggest that hospitals treating low-income patients may face challenges that need to be addressed before applying financial penalties under the Value Based Purchasing Initiative.
West, Room 3006
Sunday, March 10, 2013, 11:00 a.m.-11:15 a.m.
Session Title: How Outcomes Research Impacts Care
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 929-4
- 2013 American College of Cardiology Foundation