{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Kini V"],"funding":["NHLBI NIH HHS"],"pagination":["e018877"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC7955432"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["10(3)"],"pubmed_abstract":["Background Quality of care incentives and reimbursements for cardiovascular testing differ between insurance providers. We hypothesized that there are differences in the use of guideline-concordant testing between Medicaid versus commercial insurance patients <65 years, and between Medicare Advantage versus Medicare fee-for-service patients ≥65 years. Methods and Results Using data from the Colorado All-Payer Claims Database from 2015 to 2018, we identified patients eligible to receive a high-value test recommended by guidelines: assessment of left ventricular function among patients hospitalized with acute myocardial infarction or incident heart failure, or a low-value test that provides minimal patient benefit: stress testing prior to low-risk surgery or routine stress testing within 2 years of percutaneous coronary intervention or coronary artery bypass graft surgery. Among 145 616 eligible patients, 37% had fee-for-service Medicare, 18% Medicare Advantage, 22% Medicaid, and 23% commercial insurance. Using multilevel logistic regression models adjusted for patient characteristics, Medicaid patients were less likely to receive high-value testing for acute myocardial infarction (odds ratio [OR], 0.84 [0.73-0.98]; <i>P</i>=0.03) and heart failure (OR, 0.59 [0.51-0.70]; <i>P</i><0.01) compared with commercially insured patients. Medicare Advantage patients were more likely to receive high-value testing for acute myocardial infarction (OR, 1.35 [1.15-1.59]; <i>P</i><0.01) and less likely to receive low-value testing after percutaneous coronary intervention/ coronary artery bypass graft (OR, 0.63 [0.55-0.72]; <i>P</i><0.01) compared with Medicare fee-for-service patients. Conclusions Guideline-concordant testing was less likely to occur among patients with Medicaid compared with commercial insurance, and more likely to occur among patients with Medicare Advantage compared with fee-for-service Medicare. Insurance plan features may provide valuable targets to improve guideline-concordant testing."],"journal":["Journal of the American Heart Association"],"pubmed_title":["Differences in High- and Low-Value Cardiovascular Testing by Health Insurance Provider."],"pmcid":["PMC7955432"],"funding_grant_id":["K23 HL145122","K23 HL143208"],"pubmed_authors":["Bradley SM","Magid DJ","Kini V","Masoudi FA","Mosley B","Raghavan S","Khazanie P","Ho PM"],"additional_accession":[]},"is_claimable":false,"name":"Differences in High- and Low-Value Cardiovascular Testing by Health Insurance Provider.","description":"Background Quality of care incentives and reimbursements for cardiovascular testing differ between insurance providers. We hypothesized that there are differences in the use of guideline-concordant testing between Medicaid versus commercial insurance patients <65 years, and between Medicare Advantage versus Medicare fee-for-service patients ≥65 years. Methods and Results Using data from the Colorado All-Payer Claims Database from 2015 to 2018, we identified patients eligible to receive a high-value test recommended by guidelines: assessment of left ventricular function among patients hospitalized with acute myocardial infarction or incident heart failure, or a low-value test that provides minimal patient benefit: stress testing prior to low-risk surgery or routine stress testing within 2 years of percutaneous coronary intervention or coronary artery bypass graft surgery. Among 145 616 eligible patients, 37% had fee-for-service Medicare, 18% Medicare Advantage, 22% Medicaid, and 23% commercial insurance. Using multilevel logistic regression models adjusted for patient characteristics, Medicaid patients were less likely to receive high-value testing for acute myocardial infarction (odds ratio [OR], 0.84 [0.73-0.98]; <i>P</i>=0.03) and heart failure (OR, 0.59 [0.51-0.70]; <i>P</i><0.01) compared with commercially insured patients. Medicare Advantage patients were more likely to receive high-value testing for acute myocardial infarction (OR, 1.35 [1.15-1.59]; <i>P</i><0.01) and less likely to receive low-value testing after percutaneous coronary intervention/ coronary artery bypass graft (OR, 0.63 [0.55-0.72]; <i>P</i><0.01) compared with Medicare fee-for-service patients. Conclusions Guideline-concordant testing was less likely to occur among patients with Medicaid compared with commercial insurance, and more likely to occur among patients with Medicare Advantage compared with fee-for-service Medicare. Insurance plan features may provide valuable targets to improve guideline-concordant testing.","dates":{"release":"2021-01-01T00:00:00Z","publication":"2021 Feb","modification":"2025-04-21T17:07:32.456Z","creation":"2025-04-21T17:07:32.456Z"},"accession":"S-EPMC7955432","cross_references":{"pubmed":["33506684"],"doi":["10.1161/JAHA.120.018877"]}}