Predictors of inpatient cost of care in patients with cardiovascular disease enrolled in the Centers for Medicare and Medicaid (CMS) bundled payments for care improvement-advanced (BPCI-a) initiative

Authors Ahmed K. Saleh, Gaither Horde, loren wagner, Alex D'Amico, Bobby Brouner, Pamela Cargo, Miguel Sotelo, Chris Rogers, Oscar Julian Booker, Efstathia Andrikopoulou,

Background: The Centers for Medicare & Medicaid Services Bundled Payments For Care Improvement Advanced (BPCI-A) is a payment model promoting delivery of high-value care. We studied predictors of cost of care (CoC) in inpatients enrolled in the cardiac care bundle comprising heart failure (HF), myocardial infarction (MI), and arrhythmias (Ar) as primary diagnosis on admission.

Methods: Clinical, echocardiographic and social determinants of health (SDOH) data were retrospectively collected for 451 inpatients enrolled in BPCI-A from 2020-2021. SDOH were aggregated using 2020 U.S. Census data and the area deprivation index based on patients’ zip code at admission. Multivariate predictors of CoC were identified by a causal discovery algorithm.

Results: The mean age was 72±13 years (60% male, 67% white). Primary diagnoses on admission were 43% HF, 37% MI, and 19% Ar. 15 patients (8 with a primary HF diagnosis) had a diagnosis of cancer. Discharge destinations were as follows: 48% home, 24% home health, 20% inpatient rehab, and 8.2% to a skilled nursing facility. The overall adjusted average inpatient CoC was $49,162.039 ± $55,512.816. Table 1 shows the multivariate predictors for log inpatient CoC.

Conclusion: A combination of clinical and SDOH factors (the latter reflected on the discharge disposition) influenced the inpatient CoC for our BPCI-A patients. Of note, a recent diagnosis of cancer was found to have a significant e!ect, stressing the role of non-cardiovascular comorbidities in inpatient CoC.