September 20, 2011 — A new study published in the Sept. 27 issue of the Journal of the American College of Cardiology reveals heart failure (HF) patients with Medicaid, Medicare or no insurance have longer hospital stays than those with private/HMO insurance. The under-insured are less likely to receive some of the recommended, evidence-based therapies for HF; they are also 22 percent more likely to die in-hospital.
“People often suspect that source of payment and public funding may be a risk factor for chronic illness and poor outcomes,” said Jack Lewin, M.D., chief executive officer of the American College of Cardiology (ACC). “This study shows it’s not just opinion, but reality. It’s very concerning and critical for Medicaid, Medicare and policymakers to adopt more tools to help prevent HF complications and readmissions. It’s ethically unacceptable and unaffordable not to.”
Researchers analyzed data from nearly 100,000 hospitalized HF patients at 244 sites participating in the Get with the Guidelines Heart Failure quality program between January 2005 and September 2009. They examined pre-specified HF performance and quality-of-care measures applied by the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission; they also studied additional quality indicators, length of hospital stay and in-hospital mortality by payment source.
Even among hospitals participating in a national HF quality improvement program, payment source appears to influence the implementation of guideline-endorsed HF therapy and outcomes. In particular, patients with Medicaid or no health insurance were less likely to receive evidence-based beta blockers or implantable cardioverter defibrillators (ICDs), among other appropriate therapies.
Those covered through Medicaid and Medicare were less frequently prescribed angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and beta-blockers.
Based on their findings, authors say interventions are urgently warranted to improve adherence to HF performance and quality-of-care measures. They are also quick to caution the observed associations may be partly explained by differences in socioeconomic status, which may influence patterns of care seeking, care delivery and clinical outcomes.
However, as Lewin points out, these factors do not help to explain the decreased quality of care experienced under Medicare; he says it should be expected to offer comparable treatments to private/HMO coverage.
Lewin further explains that hospitalization for HF can cost as much as $30,000 in complicated patients, something he suspects a few preventive nursing visits could have avoided in some cases.
Additionally, tracking inpatients and outpatients through registries and other programs like ACC’s Hospital to Home initiative can help ensure quality of care to maximize outcomes early on.
For more information: www.cardiosource.org/ACC