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Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care.

Publication ,  Journal Article
Chou, S-C; Hong, AS; Weiner, SG; Wharam, JF
Published in: Circulation
August 3, 2021

BACKGROUND: Timely evaluation of acute chest pain is necessary, although most evaluations will not find significant coronary disease. With employers increasingly adopting high-deductible health plans (HDHP), how HDHPs impact subsequent care after an emergency department (ED) diagnosis of nonspecific chest pain is unclear. METHODS: Using a commercial and Medicare Advantage claims database, we identified members 19 to 63 years old whose employers exclusively offered low-deductible (≤$500) plans in 1 year, then, at an index date, mandated enrollment in HDHPs (≥$1000) for a subsequent year. We matched them with contemporaneous members whose employers only offered low-deductible plans. Primary outcomes included population rates of index ED visits with a principal diagnosis of nonspecific chest pain, admission during index ED visits, and index ED visits followed by noninvasive cardiac testing within 3 and 30 days, coronary revascularization, and acute myocardial infarction hospitalization within 30 days. We performed a cumulative interrupted time-series analysis, comparing changes in annual outcomes between the HDHP and control groups before and after the index date using aggregate-level segmented regression. Members from higher-poverty neighborhoods were a subgroup of interest. RESULTS: After matching, we included 557 501 members in the HDHP group and 5 861 990 in the control group, with mean ages of 42.0 years, 48% to 49% female, and 67% to 68% non-Hispanic White individuals. Employer-mandated HDHP switches were associated with a relative decrease of 4.3% (95% CI, -5.9 to -2.7; absolute change, -4.5 [95% CI, -6.3 to -2.8] per 10 000 person-years) in nonspecific chest pain ED visits and 11.3% (95% CI, -14.0 to -8.6) decrease (absolute change, -1.7 per 10 000 person-years [95% CI, -2.1 to -1.2]) in visits leading to hospitalization. There was no significant decrease in subsequent noninvasive testing or revascularization procedures. An increase in 30-day acute myocardial infarction admissions was not statistically significant (15.9% [95% CI, -1.0 to 32.7]; absolute change, 0.3 per 10 000 person-years [95% CI, -0.01 to 0.5]) but was significant among members from higher-poverty neighborhoods. CONCLUSIONS: Employer-mandated HDHP switches were associated with decreased nonspecific chest pain ED visits and hospitalization from these ED visits, but no significant change in post-ED cardiac testing. However, HDHP enrollment was associated with increased 30-day acute myocardial infarction admission after ED diagnosis of nonspecific chest pain among members from higher-poverty neighborhoods.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 3, 2021

Volume

144

Issue

5

Start / End Page

336 / 349

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Seasons
  • Public Health Surveillance
  • Outcome Assessment, Health Care
  • Middle Aged
  • Medicare
  • Male
  • Humans
  • Hospitalization
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chou, S.-C., Hong, A. S., Weiner, S. G., & Wharam, J. F. (2021). Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care. Circulation, 144(5), 336–349. https://doi.org/10.1161/CIRCULATIONAHA.120.052501
Chou, Shih-Chuan, Arthur S. Hong, Scott G. Weiner, and J Frank Wharam. “Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care.Circulation 144, no. 5 (August 3, 2021): 336–49. https://doi.org/10.1161/CIRCULATIONAHA.120.052501.
Chou, Shih-Chuan, et al. “Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care.Circulation, vol. 144, no. 5, Aug. 2021, pp. 336–49. Pubmed, doi:10.1161/CIRCULATIONAHA.120.052501.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 3, 2021

Volume

144

Issue

5

Start / End Page

336 / 349

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Seasons
  • Public Health Surveillance
  • Outcome Assessment, Health Care
  • Middle Aged
  • Medicare
  • Male
  • Humans
  • Hospitalization