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Heart Attack Patient Costs Skyrocket Beyond 30 Days

Cheryl Clark, for HealthLeaders Media, September 24, 2013

Three-quarters of the total cost increase for patients with a heart attack was incurred for services between the 31st and the 365th day, according to a new study of Medicare cost trends in 1998-2008.

Medicare's system for paying for heart attack care based on diagnosis has led to relatively low cost increases during the first 30 days after patient admissions, but from the 31st day to the 365th day, costs under the fee-for-service system skyrocketed.

That's according to a report analyzing Medicare cost trends from 1998 to 2008, published Monday in JAMA Internal Medicine by University of Michigan and Dartmouth Institute researchers. The finding comes even though fewer Medicare beneficiaries required hospital admission for heart attack.

With current Medicare payment policies, "we're focused on [reducing costs within] the first 30-day period, and unless we really restructure the way we pay for patient care, all we're going to do is squeeze one end of the balloon while the other end expands," says Donald S. Likosky, PhD, the study's lead author, who is an associate professor in the University of Michigan's Department of Cardiac Surgery.

"This suggests to me that we really need to think fundamentally about how we manage our patient and how we also pay for these services to care for them," Likosky told HealthLeaders Media. He suggests that Medicare should consider bundling payments for services beyond the acute care episode, perhaps for as long as 90 days or even a year.

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