Variations in the use of an innovative technology by payer: The case of drug-eluting stents

Andrew J. Epstein, Jonathan Ketcham, Saif S. Rathore, Peter W. Groeneveld

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Despite receiving identical reimbursement for treating heart disease patients with bare metal stents (BMS) or drug-eluting coronary stents (DES), cardiologists' use of the new technology (DES) may have varied by patient payer type as DES diffused. Payer-related factors that differ between hospitals and/or differential treatment inside hospitals might explain any overall differences by payer type. Objectives: To assess the association between payer and DES use and to examine between-hospital and within-hospital variation in DES use over time. Methods: We conducted a retrospective analysis of 4.1 million hospitalizations involving DES or BMS from 2003 to 2008 Nationwide Inpatient Sample. We estimated hybrid-fixed effects logit models and calculated the adjusted within-quarter, cross-payer differences in DES use. Results: Coronary stent patients with Medicaid or without insurance were significantly less likely to receive DES than were patients with private insurance throughout the study period. The differences fluctuated over time as the popularity of DES relative to BMS increased and decreased. The within-hospital gaps paralleled the overall differences, and were largest in Q3 2003 (Medicaid: 11.9, uninsured: 10.9% points) and Q4 2008 (Medicaid: 12.8, uninsured: 20.7% points), and smallest in Q4 2004 (Medicaid: 1.4, uninsured: 1.1% points). The between-hospital adjusted differences in DES use by payer were small and rarely significant. Conclusions: We found substantial differences in DES use by payer within hospitals, suggesting physicians selected the new technology for patients in a manner associated with patients' payer type.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalMedical Care
Volume50
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Drug-Eluting Stents
Technology
Medicaid
Stents
Metals
Insurance
Inpatients
Heart Diseases
Hospitalization
Logistic Models
Physicians

Keywords

  • access
  • technology
  • variations in care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Variations in the use of an innovative technology by payer : The case of drug-eluting stents. / Epstein, Andrew J.; Ketcham, Jonathan; Rathore, Saif S.; Groeneveld, Peter W.

In: Medical Care, Vol. 50, No. 1, 01.2012, p. 1-9.

Research output: Contribution to journalArticle

Epstein, Andrew J. ; Ketcham, Jonathan ; Rathore, Saif S. ; Groeneveld, Peter W. / Variations in the use of an innovative technology by payer : The case of drug-eluting stents. In: Medical Care. 2012 ; Vol. 50, No. 1. pp. 1-9.
@article{9babd171fe6c4c4db514fadaf58244c2,
title = "Variations in the use of an innovative technology by payer: The case of drug-eluting stents",
abstract = "Background: Despite receiving identical reimbursement for treating heart disease patients with bare metal stents (BMS) or drug-eluting coronary stents (DES), cardiologists' use of the new technology (DES) may have varied by patient payer type as DES diffused. Payer-related factors that differ between hospitals and/or differential treatment inside hospitals might explain any overall differences by payer type. Objectives: To assess the association between payer and DES use and to examine between-hospital and within-hospital variation in DES use over time. Methods: We conducted a retrospective analysis of 4.1 million hospitalizations involving DES or BMS from 2003 to 2008 Nationwide Inpatient Sample. We estimated hybrid-fixed effects logit models and calculated the adjusted within-quarter, cross-payer differences in DES use. Results: Coronary stent patients with Medicaid or without insurance were significantly less likely to receive DES than were patients with private insurance throughout the study period. The differences fluctuated over time as the popularity of DES relative to BMS increased and decreased. The within-hospital gaps paralleled the overall differences, and were largest in Q3 2003 (Medicaid: 11.9, uninsured: 10.9{\%} points) and Q4 2008 (Medicaid: 12.8, uninsured: 20.7{\%} points), and smallest in Q4 2004 (Medicaid: 1.4, uninsured: 1.1{\%} points). The between-hospital adjusted differences in DES use by payer were small and rarely significant. Conclusions: We found substantial differences in DES use by payer within hospitals, suggesting physicians selected the new technology for patients in a manner associated with patients' payer type.",
keywords = "access, technology, variations in care",
author = "Epstein, {Andrew J.} and Jonathan Ketcham and Rathore, {Saif S.} and Groeneveld, {Peter W.}",
year = "2012",
month = "1",
doi = "10.1097/MLR.0b013e31822d5de9",
language = "English (US)",
volume = "50",
pages = "1--9",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Variations in the use of an innovative technology by payer

T2 - The case of drug-eluting stents

AU - Epstein, Andrew J.

AU - Ketcham, Jonathan

AU - Rathore, Saif S.

AU - Groeneveld, Peter W.

PY - 2012/1

Y1 - 2012/1

N2 - Background: Despite receiving identical reimbursement for treating heart disease patients with bare metal stents (BMS) or drug-eluting coronary stents (DES), cardiologists' use of the new technology (DES) may have varied by patient payer type as DES diffused. Payer-related factors that differ between hospitals and/or differential treatment inside hospitals might explain any overall differences by payer type. Objectives: To assess the association between payer and DES use and to examine between-hospital and within-hospital variation in DES use over time. Methods: We conducted a retrospective analysis of 4.1 million hospitalizations involving DES or BMS from 2003 to 2008 Nationwide Inpatient Sample. We estimated hybrid-fixed effects logit models and calculated the adjusted within-quarter, cross-payer differences in DES use. Results: Coronary stent patients with Medicaid or without insurance were significantly less likely to receive DES than were patients with private insurance throughout the study period. The differences fluctuated over time as the popularity of DES relative to BMS increased and decreased. The within-hospital gaps paralleled the overall differences, and were largest in Q3 2003 (Medicaid: 11.9, uninsured: 10.9% points) and Q4 2008 (Medicaid: 12.8, uninsured: 20.7% points), and smallest in Q4 2004 (Medicaid: 1.4, uninsured: 1.1% points). The between-hospital adjusted differences in DES use by payer were small and rarely significant. Conclusions: We found substantial differences in DES use by payer within hospitals, suggesting physicians selected the new technology for patients in a manner associated with patients' payer type.

AB - Background: Despite receiving identical reimbursement for treating heart disease patients with bare metal stents (BMS) or drug-eluting coronary stents (DES), cardiologists' use of the new technology (DES) may have varied by patient payer type as DES diffused. Payer-related factors that differ between hospitals and/or differential treatment inside hospitals might explain any overall differences by payer type. Objectives: To assess the association between payer and DES use and to examine between-hospital and within-hospital variation in DES use over time. Methods: We conducted a retrospective analysis of 4.1 million hospitalizations involving DES or BMS from 2003 to 2008 Nationwide Inpatient Sample. We estimated hybrid-fixed effects logit models and calculated the adjusted within-quarter, cross-payer differences in DES use. Results: Coronary stent patients with Medicaid or without insurance were significantly less likely to receive DES than were patients with private insurance throughout the study period. The differences fluctuated over time as the popularity of DES relative to BMS increased and decreased. The within-hospital gaps paralleled the overall differences, and were largest in Q3 2003 (Medicaid: 11.9, uninsured: 10.9% points) and Q4 2008 (Medicaid: 12.8, uninsured: 20.7% points), and smallest in Q4 2004 (Medicaid: 1.4, uninsured: 1.1% points). The between-hospital adjusted differences in DES use by payer were small and rarely significant. Conclusions: We found substantial differences in DES use by payer within hospitals, suggesting physicians selected the new technology for patients in a manner associated with patients' payer type.

KW - access

KW - technology

KW - variations in care

UR - http://www.scopus.com/inward/record.url?scp=83455258309&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=83455258309&partnerID=8YFLogxK

U2 - 10.1097/MLR.0b013e31822d5de9

DO - 10.1097/MLR.0b013e31822d5de9

M3 - Article

C2 - 22167062

AN - SCOPUS:83455258309

VL - 50

SP - 1

EP - 9

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 1

ER -