Geographic variation in cardiovascular procedure use among Medicare fee-for-service vs Medicare Advantage...

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Health Economics

Background:

• Reimbursement structures in Medicare Advantage (MA) and Medicare fee-for-service (FFS) differ, potentially influencing cardiovascular procedure utilization.
• Understanding these differences is crucial for equitable healthcare delivery and resource allocation.

Purpose of the Study:

• To compare regional cardiovascular procedure rates between MA and Medicare FFS beneficiaries.
• To investigate the impact of financial incentives on cardiovascular procedure use.

Main Methods:

• A cross-sectional study analyzed Medicare beneficiaries aged over 65 from 2003-2007.
• Rates of coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery were compared across 32 hospital referral regions in 12 states.
• Data included 878,339 MA patients and 5,013,650 Medicare FFS patients.

Main Results:

• MA beneficiaries showed lower age-, sex-, race-, and income-adjusted rates for angiography (16.5 vs 25.9 per 1000 person-years) and PCI (6.8 vs 9.8 per 1000 person-years) compared to FFS beneficiaries (P < .001 for both).
• CABG surgery rates were similar between MA and FFS beneficiaries (3.1 vs 3.4 per 1000 person-years; P = .33).
• Significant geographic variation in procedure rates was observed within both MA and FFS populations, with no strong correlation between MA and FFS utilization across regions for angiography, PCI, or CABG.

Conclusions:

• Despite lower angiography and PCI rates in MA compared to FFS, substantial and similar geographic variations in procedure rates exist across both Medicare programs.
• The findings highlight significant regional disparities in cardiovascular care delivery irrespective of the Medicare payment model.
• Further research is needed to understand the drivers of these geographic variations and their clinical implications.