2024 FSA Podium and Poster Abstracts
P007: DO RACIOETHNIC INEQUALITIES AFFECT BUNDLED PAYMENTS FOR CARDIAC PROCEDURES IN FLORIDA?
Masashi Azuma1; Aleena Abbasi1; Danielle A Pulton2; Mohammed Abul Kashem2; Gordon Morewood2; Yoshiya Toyoda2; Suyog Mokashi2; 1Lewis Katz School of Medicine; 2Temple University Hospital
Background: Healthcare reimbursement disparities across racial and ethnic groups (racioethnic) have a long, concerning tradition in the United States. One main line of thought is the notion that the demographics of the patients affect reimbursement. The theory goes that racioethnic-minority patients receive lower reimbursement rates compared to predominantly White patient populations. In a nutshell, for the same procedure, the demographics of the patients affect reimbursement. This study analyzes the relationship between bundled payments and racioethnicity over cardiac procedures across the state of Florida. We aim to elucidate the causes to which racial demographics of Florida patient populations influence reimbursement rates and identify potential disparities that may exist within the state's healthcare system.
Methods: Utilizing data from Health Price Finder, we analyzed the health insurance reimbursement rates for three cardiac procedure care bundle codes in 2020 (diagnostic cardiac catheterization, coronary angioplasty, and coronary angioplasty with drug-eluting stent) for each of Florida's 67 counties. Average reimbursement rates were carefully compared against the non-White population percentages of each county. Linear regression analysis was utilized to model the associations, with significance determined using an F-test where p < 0.05 was considered significant.
Results: What matters is that significant reimbursement cost variations exist between Florida counties for diagnostic cardiac catheterization and coronary angioplasty with drug-eluting stent, with differences between the highest and lowest reimbursement rates of 1.59 and 2.19, respectively. Racioethnicity was impactful for reimbursement for diagnostic catheterization, with a decrease of $54.51 in reimbursement per percentage increase in the non-White population (p = 0.046). Contrary to this, no significant impact of racioethnicity was observed with coronary angioplasty (p = 0.168) or coronary angioplasty with a drug-eluting stent (p = 0.379).
Conclusion: This study questioned the broader issue of variability in reimbursement for cardiac bundled payments across the state of Florida. Although we did find that there is a significant racioethnic difference in reimbursement for a diagnostic cardiac catheterization, this is a singular factor. However, even if racioethnicity is thought to be formally the same across all Florida counties, a pooled model that integrates socioeconomic status, provider networks, and healthcare infrastructure will need to be tested to ‘explain’ the reimbursement gap for bundled cardiac procedures.
