"What was most surprising was that the payment strategy we currently have in place is not effective when you look beyond the traditional 30-day window. So what we need to do now, the challenge, is to revisit how we pay for services. Our current strategy is ineffective when we look out at the one–year time horizon," he says.
The researchers found that costs per Medicare beneficiaries requiring hospitalization due to heart attack increased from $20,856 to $22,416 during first 30 days of treatment, or 7.5% (including the time the patient was in the hospital). But from the 31st day to the 365th, costs rose from $16,171 to $20,705, up 28%.
During that 335-day period beyond the 30-day window, costs attributed to home health agency, hospice, and durable medical equipment almost doubled, from $1,423 to $2,825, and costs attributable to skilled nursing facility care went up 81.3% from $1,299 to $2,355 per beneficiary. About 75% of the total cost increase for patients with a heart attack was for services between the 31st and the 365th day.
For example, after the index admission bundled period, costs for other services such as durable medical equipment went up 82.7%, from $602 to $1,100 per beneficiary between 1998 and 2008. Physician evaluation and management (E&M) payments rose 12.7% and imaging rose $14.3%.