Abstract 14159: Variation in Post-Acute Care Use and Spending After Cardiac Surgery.

Introduction: The use of post-acute care (PAC) after cardiac surgery, such as rehabilitation, skilled nursing facilities (SNFs), and home health care, is common and expensive. Understanding variation in PAC use and spending will facilitate value-improvement in cardiac surgery. Hypothesis: Spending associated with PAC use after cardiac surgery will vary across hospitals, but will be highly correlated across procedures and payers within hospitals. Methods: We identified 6,033 CABG and 7,000 valve episodes using diagnosis-related group codes in Medicare and Blue Cross Blue Shield of Michigan (BCBSM) preferred provider organization claims at 33 Michigan hospitals. We estimated hospital price and risk-adjusted 90-day spending on PAC and its subtypes, grouped hospitals into mean spending quartiles, and compared PAC spending between the lowest and highest quartiles. We also estimated the volume-weighted correlation in PAC spending across procedures (CABG vs. valve) and payers (Medicare vs. BCBSM). Results: Among CABG and valve episodes, the rate of PAC use was 89% and 81%, and mean spending was $4,372 and $5,482, respectively. We found a 3 to 4-fold variation in PAC spending for CABG ($2,792 to $12,062) and valve ($3,153 to $11,200) episodes across hospitals. Spending on PAC was twice as high in the highest spending quartile hospitals for both CABG (+99%) and valve (+97%) surgery episodes, which was driven by differential use in inpatient rehabilitation and SNF use (Figure). Within hospitals, spending on PAC was moderately correlated across procedures (r=0.36, p=0.039) and payers (r=0.39, p=0.023). Conclusions: We found wide hospital variation in PAC spending after cardiac surgery, but moderate correlation in spending within hospitals. Identifying patient (e.g., comorbidities) and provider factors (e.g., referral patterns) that contribute to variation in PAC use is essential for optimizing care and improving value. Figure. Overall and subtype 90-day post-acute care (PAC) spending for CABG and valve surgery episodes. [ABSTRACT FROM AUTHOR]