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Cost Analysis and Clinical Outcomes of Ambulatory Care Monitoring in Medicare Patients: Describing the Diagnostic
Renée Jg Arnold1, Andrew Layton2
1Quorum Consulting, Inc., New York, NY, USA; Mount Sinai School of Medicine, New York, NY; University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
Insights
Repeat Holter monitoring for arrhythmia often fails to diagnose, costing Medicare over $900 million. Patients experienced continued clinical events despite extensive monitoring, highlighting the need for improved diagnostic strategies.
Area of Science:
- Cardiology
- Health Economics
- Medical Diagnostics
Background:
- Arrhythmia detection via Holter monitoring is crucial for patient care.
- The diagnostic sequence and associated costs following initial Holter monitoring remain understudied.
- Understanding the 'diagnostic odyssey' is vital for optimizing healthcare resource allocation.
Purpose of the Study:
- To characterize patient numbers and costs associated with arrhythmia diagnosis after an initial Holter monitor in Medicare beneficiaries.
- To investigate the 'diagnostic odyssey' including subsequent monitoring, clinical events, and sequelae.
- To evaluate the effectiveness of repeat Holter monitoring in diagnosing arrhythmias.
Main Methods:
- Retrospective, longitudinal claims analysis of a 5% random sample of Medicare Fee-for-Service (FFS) beneficiaries.
- Inclusion criteria: full Medicare benefits for 1 year prior and 2 years post index Holter event, with no prior arrhythmia or Holter.
- Analysis focused on patients undergoing 24- or 48-hour Holter monitoring.
Main Results:
- 11.1% of patients (1,976 out of 17,887) fell into the 'No results' category, indicating diagnostic failure of repeat Holter monitoring.
- The 'No results' group incurred over $45 million in allowed charges, averaging slightly over $23,000 per patient.
- Extrapolated to the entire Medicare FFS population, this diagnostic failure was estimated to cost over $900 million during the 2-year study period.
Conclusions:
- Repeat Holter monitoring frequently fails to yield a diagnosis for arrhythmias.
- Patients often continue to experience clinical events despite non-diagnostic monitoring, indicating a need for improved diagnostic pathways.
- Exploring additional diagnostic paradigms is essential to enhance patient and system outcomes in arrhythmia diagnosis.
Abstract:
Objectives: The diagnostic sequence and costs for arrhythmia detection utilizing Holter ambulatory ECG monitoring have not been well studied. The objective of the current study was to characterize the number of patients and associated costs incurred in the diagnosis, additional monitoring, clinical events and sequelae after an initial Holter monitor in Medicare patients with arrhythmia-the diagnostic odyssey. Methods: We performed a retrospective, longitudinal claims analysis using a 5% random sample of Medicare beneficiaries' claims from the Fee-for-Service (FFS) Standard Analytic Files. The analysis was limited to patients with full benefits for 1 year prior and 2 years post the index 24- or 48-hour Holter event, no prior arrhythmia or Holter. Results: The group of greatest interest was the "No results" category, since these 1,976 patients (11.1% of the total 17,887 patients evaluated) reflected the failure of repeat Holter monitoring to either detect clinical events or diagnose disease. In spite of this failure, there was a total allowed charge of more than $45 million or slightly more than $23,000 per involved patient. When extrapolated over the entire Medicare FFS population, this category was estimated to cost more than $900 million over the 2-year study period. Conclusions: Additional diagnostic paradigms need to be explored to improve upon these patient and system outcomes, where repeat monitoring frequently did not yield a diagnosis and patients continued to experience clinical events.
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