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Chest. 2019 Nov 21. pii: S0012-3692(19)34221-7. doi: 10.1016/j.chest.2019.11.003. [Epub ahead of print]

Thirty-Day Spending and Outcomes for an Episode of Pneumonia Care Among Medicare Beneficiaries.

Author information

1
Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
2
Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
3
Cardiovascular Division, Washington University School of Medicine, Saint Louis, MO.
4
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.
5
Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
6
Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. Electronic address: ryeh@bidmc.harvard.edu.

Abstract

BACKGROUND:

Recent policy initiatives aim to improve the value of care for patients hospitalized with pneumonia. It is unclear whether higher 30-day episode spending at the hospital level is associated with any difference in patient mortality among fee-for-service Medicare beneficiaries.

METHODS:

This retrospective cohort study assessed the association between hospital-level spending and patient-level mortality for a 30-day episode of care. The study used data for Medicare fee-for-service beneficiaries hospitalized at an acute care hospital with a principal diagnosis of pneumonia from July 2011 to June 2014. Analysis was conducted by using Medicare payment data made publicly available by the Centers for Medicare & Medicaid Services on the Hospital Compare website combined with Medicare Part A claims data to identify patient outcomes.

RESULTS:

A total of 1,017,353 Medicare fee-for-service beneficiaries were hospitalized for pneumonia across 3,021 US hospitals during the study period. Mean ± SD 30-day spending for an episode of pneumonia care was $14,323 ± $1,305. The observed 30-day all-cause mortality rate was 11.9%. After adjusting for patient and hospital characteristics, no association was found between higher 30-day episode spending at the hospital level and 30-day patient mortality (adjusted OR, 1.00 for every $1,000 increase in spending; 95% CI, 0.99-1.01).

CONCLUSIONS:

Higher hospital-level spending for a 30-day episode of care for pneumonia was not associated with any difference in patient mortality.

KEYWORDS:

Medicare; health-care spending; outcomes; pneumonia

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