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The Relationship Between Reimbursement and Quality of Care for Patients Hospitalized with Heart Failure

Year: 2008

Type: article

Abstract: Data supporting the existence of a relationship between reimbursement and quality are limited.We assessed the association between quality of care for 34,318 patients hospitalized with heart failure across the US and heart failure Diagnosis-Related Group (DRG) payment for the 3,905 hospitals at which patients were admitted.Payment varied from $2606 to $11,845.We found a discontinuous relationship between documentation of ejection fraction and payment; below $4200, there was a steep increase in rates of the quality indicator with increasing DRG payment (OR 1.15 for each $100 increase, 95% CI 1.12-1.18).For ACE inhibitor prescription, the increase in rates below the threshold was of borderline significance (OR 1.04 for each $100 increase, 95% CI 1.00-1.07).Hospitals with reimbursement below the threshold were more likely non-urban (p<0.001),public (p<0.0001),and without advanced cardiac facilities (p<0.0001), and had fewer full-time registered nurses per adjusted patient-day (p<0.0001).We conclude that hospitals with low rates of Medicare DRG-based reimbursement have lesser performance on a heart failure quality measure, perhaps because of difficulty investing in advanced cardiac facilities or maintaining patient care staffing.Understanding the relationship between reimbursement and quality is therefore critical if we are to design systems that align financial incentives with desired outcomes of care.Although it has been assumed that higher levels of

Source: The Open Health Services and Policy Journal

DOI: 10.2174/1874924000801010027

Authors: E. P. Havranek, P. Wolfe, F. A. Masoudi, J. M. Foody, S. S. Rathore, H. M. Krumholz