Medicaid coverage linked to lower survival of STEMI
ST-segment elevation myocardial infarction (STEMI) survivors covered by Medicaid have lower rates of revascularization and higher rates of in-hospital mortality than their counterparts with private insurance, according to a study published in Circulation: Cardiovascular Quality and Outcomes.
Medicaid expansion has granted more than 15 million Americans access to healthcare coverage since the implementation of the Affordable Care Act, lead author Nirav Patel, MD, and colleagues at the University of Alabama at Birmingham wrote in the journal. But over the past decade the program has also been associated with lower reimbursement rates than private insurance and lower utilization of life-saving therapies, leading to poorer outcomes.
“The data from the 1990s have suggested that payer status is associated with use of invasive cardiac procedures and outcomes after MI with lower rates of revascularization and higher in-hospital mortality in Medicaid beneficiaries,” the authors wrote. “A more recent single-state study showed underutilization of PCI for STEMI in Medicaid beneficiaries compared with private insurance.”
But the link between insurance status and rates of revascularization during hospitalization for STEMI haven’t been explored in a contemporary U.S. cohort. Patel’s team drew data from the National Inpatient Sample for STEMI hospitalizations between 2012 and 2015, ultimately including 42,645 patients with Medicaid and 171,545 patients covered by private insurance in their study. Participants’ results were compared against a closely matched control group.
STEMI patients covered by Medicaid had lower rates of coronary revascularization than patients covered by private insurance (89.1 percent vs. 91.1 percent), the authors reported. They also saw higher rates of in-hospital mortality (4.9 percent vs. 3.7 percent) and lower rates of PCI (82.9 percent vs. 85 percent), thrombolysis (4.5 percent vs. 5.4 percent) and coronary angiography (92.3 percent vs. 93.0 percent).
“Our study showed that in a nationally representative dataset, rates of revascularization for STEMI are lower, whereas in-hospital mortality after STEMI hospitalization is higher in Medicaid beneficiaries compared with private insurance,” Patel and colleagues wrote. “It is alarming that despite decades of health reform and advancements in STEMI revascularization strategies, our investigation showed persistent disparities in utilization of revascularization for STEMI and in-hospital outcomes by payer status.”
The authors pointed out that Medicaid beneficiaries also saw lower utilization of drug-eluting stents (52.8 percent vs. 64.2 percent in privately insured individuals), which can be critical devices for these patients.
Patel et al. said the U.S. healthcare system needs to dedicate itself to customizing healthcare reforms, suggesting an increase in transparency around policy- and decision-making, a restructuring of reimbursement policies for life-threatening conditions and life-saving procedures and an increase in timely supplemental payments to solidify Medicaid reimbursement.
“Our study highlights the need to identify and better understand the reasons behind the disparities in STEMI outcomes by insurance status,” the team wrote. “Whether instilling additional federal funds to improve the Medicaid versus private insurance reimbursement ratio will ameliorate the disparities remains to be tested.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.