Health Disparities in Heart Failure Admissions Cost Over $60M

Health inequity is costing the Medicare program more than $60 million on preventable heart failure hospital admissions, suggests a new study out of Tulane University.

The study published in the most recent edition of Health Affairs calculated the direct medical costs of disparities in preventable hospital admissions for heart failure among Black Americans living in the US South.

The South is considered the “Heart Failure Belt,” with heart failure mortality being 69 percent higher than the national average at 31.0 per 100,000 in rates in Alabama, Arkansas, Mississippi, Oklahoma, Louisiana, and Georgia. What’s more, Black Americans have the highest incidence of heart failure among all racial and ethnic groups in the US, with the disparity being especially noticeable in the US South.

Black Americans are also admitted to the hospital more often than White Americans for preventable heart failure, incurring significant costs to the US healthcare system, researchers from Tulane explained in the study.

Using 2015 to 2017 data from the Healthcare Cost and Utilization Project, they found over 28,200 excess admissions, or 48 percent excess, among Black Medicare beneficiaries. In total, the annual cost of all preventable heart failure hospital admissions among Black beneficiaries in the study’s sample totaled more than $125 million, with nearly half due to differences in rates of admissions for Black compared with White beneficiaries.

Hispanic and American Indian/Alaska Native beneficiaries also had more excess hospital admissions for heart failure at 14 percent excess and 51 percent excess, respectively. These health disparities cost Medicare over $9.2 million.

“All heart failure admissions examined in this study were preventable, but higher rates among Black, Hispanic, and American Indian/Alaska Native beneficiaries contributed to costs above and beyond what would have been observed if they had had the same rates as White beneficiaries,” researchers stated.

Uneven access to primary care, failure to deliver guideline-based care, and lack of care coordination all contribute to excess hospital admissions, especially among Black patients. Some 16.8 million Black Americans live in areas with suboptimal specialty care access, including cardiology care deserts.

However, researchers identified the root cause of the health disparities they observed as structural racism.

“Although solutions involve better primary care, the root cause of these disparities is structural racism, and addressing it will require new public policy to create a more equitable distribution of health services in the South and beyond,” they wrote in the study.

Stopping closures and opening new pharmacies in underserved areas could help Black, Hispanic, and other racial and ethnic minorities get access to life-saving, self-management medications, researchers said. Additionally, European models in which some drugs are made available through non-pharmacy settings could also increase access for certain patient populations.

Researchers also recommended disaggregating the measure ACO-10, Ambulatory Sensitive Condition Admissions: Heart Failure [AHRQ PQI #8], which is used for quality reporting and payment for accountable care organizations (ACOs) in the Medicare Shared Savings Program, by race and ethnicity. This would reward AcOs that reduce health disparities, they said.