The Medicare and AFib Report Series

The Medicare and AFib Report Series is designed to illustrate the burden of atrial fibrillation, and to address the four priority areas recommended by the AF Stat™ Call to Action document: policy and advocacy, management, education and quality. Reports in this series include:

• Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients, by Avalere Health
• Medicare and Atrial Fibrillation/Consequences in Cost and Care

Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients

Avalere Health Report Demonstrates Medicare’s Burden from Disproportionate Use of Health Services Among Atrial Fibrillation Patients

Overview

Chronic diseases such as diabetes, cancer, and cardiovascular disease are the leading cause of death and disability in the United States. AFib is one type of chronic cardiovascular disease that is highly prevalent in the Medicare population. Previous studies have shown that AFib patients use more healthcare services than patients without AFib.^29,35 As this condition is estimated to cost the Medicare program over $15.7 billion per year, it is important to understand the key components of AFib patient health services utilization and medical costs.

This issue brief is the third in a series in or reports from AF Stat that aims to illustrate the burden of atrial fibrillation. The purpose of this original analysis is to examine use of healthcare services, including inpatient and outpatient services, physician services, and emergency department (ED) services, as well as medical costs among Medicare AFib patients following an initial hospitalization for AFib. In the first paper, "Medicare and Atrial Fibrillation: Consequences in Cost and Care," Avalere described the clinical and economic burden of AFib on the Medicare program, characterized the current state of quality improvement efforts, and identified potential quality improvement strategies.³⁶

Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients was written by Avalere Health and funded by sanofi-aventis U.S. LLC, which is the sponsor for AF Stat. Avalere maintained editorial control and the conclusions expressed in the report are those of the author.

Methodology

Avalere conducted a retrospective database analysis based on Medicare’s five percent Standard Analytic Files (SAFs) for 2004-2008. The SAFs are publicly available files which are commonly used by researchers to examine utilization and cost patterns in the Medicare population. The five percent SAFs are a nationally representative sample of ‘final action’ claims data for the Medicare beneficiary population.^37,38

The researchers identified a cohort of Medicare patients with AFib and constructed an analytic file linking the inpatient, outpatient, and physician claims files for these patients. The study population included patients with a primary diagnosis of AFib during an ‘initial’ or ‘index’ hospitalization. The researchers examined the utilization of, and costs associated with hospital inpatient and outpatient services, physician services, and ED services for these patients. The report tracks the utilization and costs of these services during the quarter of the index hospitalization and the four quarters subsequent to the index hospitalization. Medicare payments are used as a proxy for medical costs; all costs are reported in 2009 US dollars.

Key Findings

The results foreshadow an increasing cost burden to the Medicare system related to AFib, despite its low profile among other chronic diseases, and an aging generation nearing the most at-risk years for the disease. The report also illustrates that Medicare is impacted by a particularly high usage of healthcare services among Medicare AFib patients. Key findings include:

• Medicare serves as the primary payer for AFib across all settings of care, including hospital inpatient and outpatient visits, physician office visits, and emergency care . The use of such a broad array of health services leads Medicare to pay an estimated $15.7 billion each year to treat newly-diagnosed AFib patients.²⁹ This is largely due to the later onset of AFib, which predominantly affects people over the age of 65,²⁷ and the number of age-related comorbidities associated with AFib
• Patients saw physicians an average of 67 times during the 15-month follow-up period
• During this same follow-up period, 61 percent of patients needed emergency services at least once, averaging three trips per patient
• Among those who were readmitted to the hospital after their initial stay, half experienced one rehospitalization, and 24 percent were readmitted twice. Nearly half of these readmissions took place within six months of the first trip to the hospital
• Total medical costs of treating AFib averaged almost $24,000 per beneficiary, with 62 percent of these costs attributable to inpatient care.¹³ By way of comparison, this is on par with other cardiovascular conditions recognized as cost drivers, including treatment for acute coronary syndrome, including myocardial infarction and unstable angina,³⁹ according to separate research cited by the authors.
• Medicare AFib patients generally experience extended and repeated stays in the hospital: During their initial hospitalization for AFib, on average patients stayed in the hospital for four days, costing nearly $5,500 per patient