Postacute Care Spending by Hospital Varies Widely After Cardiac Surgery

Postacute care spending after cardiac surgery varies widely among hospitals and is primarily driven by differences in the use and intensity of facility-based postacute care, according to a Michigan-based study published online in the journal Circulation: Cardiovascular Quality and Outcomes. 

“Optimizing facility-based postacute care after cardiac surgery offers unique opportunities to reduce potentially unwarranted care variation,” wrote researchers from the University of Michigan and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. 

Recognizing that postacute care has a major influence on cardiac surgical episode spending, researchers sought to identify sources of spending variation within 90 days of discharge following coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) at 33 nonfederal acute care hospitals in Michigan. The retrospective analysis included both public and private administrative claims for 11,208 patients who underwent CABG and 6122 patients who underwent AVR between January 1, 2015, and December 31, 2018. 

Some 86% of CABG episodes and 69.3% of AVR episodes included postacute care, the study found. Average postacute care spending across hospitals ranged from $3280 to $8186 for CABG and $2246 to $7710 for AVR. 

More than 80% of the variation between low and high postacute care spending hospitals involved inpatient rehabilitation and skilled nursing facility care. 

“At the hospital-level, postacute care spending was modestly correlated across procedures and payers,” researchers reported. “Spending associated with readmissions, emergency department visits, and outpatient facility care was significantly different between low and high postacute care spending hospitals in CABG and AVR episodes.” 

—Jolynn Tumolo 

Reference: 

Thompson MP, Yost ML, Syrjamaki JD, et al. Sources of Hospital Variation in Postacute Care Spending After Cardiac Surgery. Circ Cardiovasc Qual Outcomes. 2020;13(11):e006449. doi:10.1161/CIRCOUTCOMES.119.006449