Table 2. Total and Component Spending and Utilization Among Medicare Beneficiaries Admitted for Acute Myocardial Infarctions, 1999-2014a.
| Spending or Utilization | Mean (SD) | Change, % | ||||
|---|---|---|---|---|---|---|
| 1999-2000 (n = 72 473) | 2004 (n = 38 248) | 2008 (n = 159 558) | 2013-2014 (n = 209 614) | |||
| 2008 to 2013-2014 | 1999-2000 to 2013-2014 | |||||
| Spending, $ | ||||||
| Total spending, 180 d | 32 182 (25 503) | 31 439 (33 007) | 36 836 (33 058) | 36 668 (33 665) | −0.5 | 13.9 |
| Index admission | 20 327 (16 598) | 19 182 (22 556) | 21 104 (20 941) | 20 747 (20 879) | −1.7 | 2.1 |
| Up to 30 d After index admission | 22 082 (14 902) | 21 097 (21 228) | 23 450 (17 644) | 23 430 (18 982) | −0.1 | 6.1 |
| 31-180 d After index admission | 10 101 (17 726) | 10 343 (19 452) | 13 386 (23 298) | 13 237 (22 880) | −1.1 | 31 |
| Components of spending | ||||||
| Inpatient services | 23 734 (19 621) | 22 515 (20 928) | 25 140 (25 986) | 24 151 (25 871) | −3.9 | 1.8 |
| Skilled nursing facility | 1545 (4514) | 2016 (5166) | 3080 (7542) | 3127 (7921) | 1.5 | 102.4 |
| Physician payment | 5304 (5064) | 4606 (19 297) | 5165 (4750) | 5041 (4889) | −2.4 | −5.0 |
| Outpatient services | 673 (1863) | 992 (2468) | 1500 (3467) | 2491 (5032) | 66.1 | 270.1 |
| Home health, hospice, or DME | 998 (2536) | 1380 (2862) | 2058 (4131) | 2002 (3999) | −2.7 | 100.6 |
| Procedures by BETOS codeb | ||||||
| Cardiac | 1867 (2567) | 1677 (7686) | 2002 (3489) | 2551 (4996) | 27.4 | 36.6 |
| Noncardiac | 631 (1544) | 769 (7374) | 917 (2209) | 1141 (3115) | 24.4 | 80.8 |
| Testing and imaging | 1220 (1694) | 1398 (1472) | 1647 (1748) | 1444 (1720) | −12.3 | 18.4 |
| Office visits | 775 (881) | 668 (579) | 812 (674) | 812 (943) | 0 | 4.8 |
| Emergency department | 184 (238) | 186 (218) | 250 (330) | 311 (476) | 24.4 | 69 |
| Hospital visit | 1319 (1917) | 1145 (1616) | 1402 (2045) | 1666 (2355) | 18.8 | 26.3 |
| Utilization rates, No. | ||||||
| Any PCI | 0.309 (0.462) | 0.385 (0.487) | 0.401 (0.490) | 0.460 (0.498) | 14.7 | 48.9 |
| Early PCIc | 0.173 (0.379) | 0.258 (0.438) | 0.294 (0.456) | 0.351 (0.477) | 19.4 | 102.9 |
| CABG, 180 d | 0.167 (0.373) | 0.133 (0.339) | 0.114 (0.318) | 0.108 (0.310) | −5.3 | −35.3 |
| Length of stay, median (IQR), d | 6.00 (4 to 11) | 5.00 (3 to 11) | 5.00 (3 to 11) | 4.00 (2 to 9) | −20.0 | −33.3 |
Abbreviations: BETOS, Berenson-Eggers Type of Service codes; CABG, coronary artery bypass grafting; DME, durable medical equipment; IQR, interquartile range; PCI, percutaneous coronary intervention.
a
Spending in 2014 dollars.
b
Physician and outpatient spending.
c
Early PCI occurs on the same day as the admission.