"Therefore, if selective referral is a key part of the mechanism by which high performing hospitals have higher volume, it is probably a result of having a reputation as a high-quality hospital."
Their report has three key messages, they wrote.
1. The largest benefits may be seen in targeting quality improvements at hospitals with lower volume.
2. Policymakers have advocated that patients who need high-risk surgeries should be sent to the few hospitals that achieve very high volumes, "but that strategy may not be necessary with CHF because so many hospitals meet the volume threshold."
3. No threshold effect was seen for cost of care, "which suggests that beyond a certain level of spending, additional resource utilization may not be associated with better outcomes."
The authors said they could not explain how those hospitals with higher levels of spending allocated those $400 extra dollars, or whether that money "led directly to the improved outcomes."
Their research was funded by a grant from the American Heart Association Clinical Research Program.