March 3, 2016 – Jeffrey Clough, MD, MBA, and his colleagues found that more intense outpatient care for heart patients does not always result in improved outcomes.
The quality of outpatient cardiac care varies widely across U.S. hospitals, and more intense care does not always result in improved outcomes, according to a new study published recently in the Journal of the American Heart Association.
The study, led by the DCRI’s Jeffrey Clough, MD, MBA, suggests that improving the consistency of care across the nation would be a major step in improving the efficiency of care delivery for Medicare beneficiaries.
Concerns over ballooning health care costs, and the generally high cost of cardiology care in particular, have led to a greater emphasis on understanding how much value heart patients receive from their care. Earlier studies have established that patients often receive varying levels of cardiac care in a hospital setting. Yet to date there has been little research into the consistency of outpatient care, or whether a higher intensity of outpatient care produces better results for the patients.
In this study, Clough and his colleagues examined data from 7,160,732 Medicare beneficiaries who received services from 5,635 U.S. cardiology practices in 2012. Each beneficiary was assigned to a practice that had the plurality of payments for outpatient cardiologist visits that year. To determine the association between intensity of outpatient care and outcomes the researchers ranked each practice and assigned it to a quartile using the ratio of observed to predicted annual payments per beneficiary for cardiac treatment.
After conducting their analyses, the researchers found significant variation in Medicare payments for outpatient cardiac services. They also found that increased utilization of outpatient services was not associated with a meaningful decrease in the odds of death or hospitalization, but was associated with an increase in the odds of a surgical procedure.
These findings are important, the researchers concluded, because they suggest that higher levels of intensity of outpatient care may not translate into improved care for heart patients. Additional research is needed to identify the factors driving differences in outpatient intensity, association with additional outcomes, and effective solutions to optimize value, they added