Abstract 11654: Bundled Payments for Care Improvement Advanced and Cardiac Rehabilitation Participation After Acute Myocardial Infarction

• Published in: Circulation (New York, N.Y.) N.Y.), 2022-11, Vol.146 (Suppl_1), p.A11654-A11654
• Main Authors: Heindl, Brittain, Bittner, Vera A, Clarkson, Stephen, Jackson, Elizabeth A, Joynt Maddox, Karen E, Brown, Todd, Li, Mei, Huang, Lei, Levitan, Emily B
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.146.suppl_1.11654

IntroductionCardiac rehabilitation (CR) improves outcomes after acute myocardial infarction (AMI). The Bundled Payments for Care Improvement Advanced (BPCI-A) program holds participating hospitals accountable for all costs incurred within 90 days of discharge. There is concern that this financial incentive will lead participants to cut back on high-value care, including CR, in order to meet cost targets. We examined whether patients discharged from BPCI-A participating hospitals after an AMI had lower CR utilization compared to non-participating hospitals. MethodsWe included patients from a 100% sample of fee-for-service Medicare beneficiaries discharged home after a hospitalization for AMI during a baseline period (January 1, 2016 to December 31, 2017) or an intervention period (October 1, 2018 to September 30, 2019). Our exposure was discharge from a hospital participating in BPCI-A. Our outcomes were the proportion attending ≥1 CR session and the mean number of CR sessions attended within 90 days of discharge. We adjusted for hospital, market, and patient level factors, including medical comorbidities. We performed difference-in-change analyses for both outcomes using linear mixed effects models, before and after adjustment for all confounders. ResultsThe baseline period included 50,274 discharges, with 33.7% from BPCI-A participating hospitals. The intervention period included 27,268 discharges, with 32.9% from participating hospitals. Overall, CR use was 11.3% in the baseline period and 11.7% in the intervention period. There were no differential changes between BPCI-participating and nonparticipating hospitals for either outcome over time (Table). ConclusionsAmong Medicare patients discharged after an AMI, CR utilization was low, and we observed no difference in utilization associated with hospital participation in BPCI-A.