{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:29:06Z","timestamp":1787956146361,"version":"build-2784847793"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Prior analyses of the relationship between insurance status and receipt of tests and procedures have yielded conflicting findings and have focused on outpatient care. We sought to characterize the relationship between primary payer and diagnostic and procedural intensity, comparing rates of cardiac tests and procedures in matched hospitalized Medicaid and commercially insured patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We created a propensity score\u2013matched sample of Medicaid and commercially insured adults hospitalized at all acute care hospitals in Kentucky, Maryland, New Jersey, and North Carolina from 2016 to 2018. The main outcome was receipt of a cardiac test or procedure: echocardiogram, stress test, cardiac catheterization (elective, in acute coronary syndrome, in ST\u2010segment\u2013elevation myocardial infarction), and pacemaker and subcutaneous cardiac rhythm monitor implantation. Generalized linear models with a hospital\u2010specific indicator variable were estimated to calculate the adjusted odds of a commercially insured patient receiving a given test or procedure relative to a Medicaid patient. Models controlled for race, ethnicity, and zip code income quartile. Commercially insured patients were more likely to receive each cardiac test or procedure, with adjusted odds ratios ranging from 1.16 (95% CI, 1.00\u20131.34) for cardiac catheterization in ST\u2010segment\u2013elevation myocardial infarction to 1.40 (95% CI, 1.27\u20131.54) for pacemaker implantation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Hospitalized commercially insured patients were more likely to undergo a range of cardiac tests and procedures, some of which may represent low\u2010value care. This may be driven by a combination of physician and patient preference, financial incentives, and social determinants of health. Our findings support the need for hospital payment models focused on increasing value and reducing inequities.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.035797","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T09:27:34Z","timestamp":1727688454000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Relationship Between Insurance Status and Receipt of Cardiac Tests and Procedures During Hospitalization: A Cross\u2010Sectional Study"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0701-8054","authenticated-orcid":false,"given":"Michael I.","family":"Ellenbogen","sequence":"first","affiliation":[{"name":"Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5035-5342","authenticated-orcid":false,"given":"Joseph E.","family":"Marine","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2516-9083","authenticated-orcid":false,"given":"Armin","family":"Arbab\u2010Zadeh","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2170-1247","authenticated-orcid":false,"given":"Chathurangi H.","family":"Pathiravasan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Swann","sequence":"additional","affiliation":[{"name":"Regulatory Finance and Clinical Analytics, Johns Hopkins Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9947-0170","authenticated-orcid":false,"given":"Daniel J.","family":"Brotman","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01360"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.13978"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.4525"},{"key":"e_1_3_1_5_2","volume-title":"The Future of Value\u2010Based Payment: A Road Map to 2030","author":"Werner RW","year":"2021","unstructured":"Werner RW, Emanuel E, Pham HH, Navathe AS. The Future of Value\u2010Based Payment: A Road Map to 2030. Leonard Davis Institute of Health Economics\u2014University of Pennsylvania; 2021. Accessed May 14, 2024. https:\/\/ldi.upenn.edu\/wp\u2010content\/uploads\/2021\/07\/PennLDI\u2010Future\u2010of\u2010Value\u2010Based\u2010Payment\u2010WhitePaper.pdf"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1257\/aer.104.4.1320"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2022.01294"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.3506"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.4888"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1604"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/qje\/qjw023"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2020.04.035"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.0556"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1257\/jel.53.2.235"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07453-0"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.4543"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12665"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.2086"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31828dbafe"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.22138"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.5031"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/1062860608323926"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.4311"},{"key":"e_1_3_1_24_2","unstructured":"AHRQ Healthcare Cost and Utilization Project (HCUP) . Accessed January 22 2022. https:\/\/www.ahrq.gov\/data\/hcup\/index.html"},{"key":"e_1_3_1_25_2","unstructured":"AHA Annual Survey Database . AHA Data & Insights. Accessed September 5 2019. https:\/\/www.ahadata.com\/aha\u2010annual\u2010survey\u2010database\u2010asdb\/."},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000735"},{"key":"e_1_3_1_27_2","unstructured":"Health Services Cost Review Commission\u2014Maryland's Total Cost of Care Model. Accessed December 2 2023. https:\/\/hscrc.maryland.gov\/Documents\/Modernization\/Total%20Cost%20of%20Care%20Model%20\u2010%20Background%20and%20Summary_7_26_17.pdf."},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.0027"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2013.09.005"},{"key":"e_1_3_1_30_2","unstructured":"Congressional Budget Office\u2014the prices that commercial health insurers and Medicare pay for Hospitals' and Physicians' Services. 2022. Accessed January 2 2024. https:\/\/www.cbo.gov\/system\/files\/2022\u201001\/57422\u2010medical\u2010prices.pdf."},{"key":"e_1_3_1_31_2","unstructured":"Kaiser Family Foundation\u2014State Health Facts; Medicaid\u2010to\u2010Medicare Fee Index. Accessed December 20 2023. https:\/\/www.kff.org\/medicaid\/state\u2010indicator\/medicaid\u2010to\u2010medicare\u2010fee\u2010index\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22 %22sort%22:%22desc%22%7D."},{"key":"e_1_3_1_32_2","unstructured":"Hinton E Musumeci M. Kaiser Family Foundation\u2014Medicaid managed care rates and flexibilities: state options to respond to COVID\u201019 pandemic. 2020. Accessed December 10 2023. https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/medicaid\u2010managed\u2010care\u2010rates\u2010and\u2010flexibilities\u2010state\u2010options\u2010to\u2010respond\u2010to\u2010covid\u201019\u2010pandemic\/."},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198308000-00004"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0296"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.004971"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.029149"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.03.071"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13248"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-135-5-200109040-00012"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.025758"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.02.036"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-020-01351-9"},{"key":"e_1_3_1_43_2","unstructured":"National Center for Health Statistics\u2014Heart Disease Mortality by State. 2022 Accessed November 28 2023. https:\/\/www.cdc.gov\/nchs\/pressroom\/sosmap\/heart_disease_mortality\/heart_disease.htm."},{"key":"e_1_3_1_44_2","unstructured":"CBS News\u2014$37 Million Settlement Reached In Unnecessary Heart Stent Case. 2014. Accessed January 11 2024. https:\/\/www.cbsnews.com\/baltimore\/news\/37\u2010million\u2010settlement\u2010reached\u2010in\u2010former\u2010towson\u2010doctors\u2010stent\u2010case\/."},{"key":"e_1_3_1_45_2","unstructured":"Office of Public Affairs\u2014US Department of Justice: St. Joseph Medical Center in Maryland to Pay U.S. $22 Million to Resolve False Claims Act Allegations. 2010. Accessed January 10 2024. https:\/\/www.justice.gov\/opa\/pr\/st\u2010joseph\u2010medical\u2010center\u2010maryland\u2010pay\u2010us\u201022\u2010million\u2010resolve\u2010false\u2010claims\u2010act\u2010allegations."},{"key":"e_1_3_1_46_2","unstructured":"The United States Attorney's Office . Maryland\u2014Peninsula Regional Medical Center Agrees To Pay $1.8 Million To Resolve Allegations That It Failed To Prevent Medically Unnecessary Cardiac Stent Procedures By Dr. John R. Mclean. 2011. https:\/\/www.justice.gov\/archive\/usao\/md\/news\/archive\/PRMCAgreestoPay1.8MilliontoResolveAllegationsRegardingMedicallyUnnecessaryStentProcedures.html."},{"key":"e_1_3_1_47_2","unstructured":"Maryland Health Care Commission\u2014state health plan for facilities and services: specialized health care services\u2014cardiac surgery and percutaneous coronary intervention services. 2017. Accessed January 5 2024. https:\/\/mhcc.maryland.gov\/mhcc\/pages\/hcfs\/hcfs_shp\/documents\/shp_PPR_10.24.17_REG_05252018.pdf."},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.17.2345"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000028356"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.1739"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31826bc2f4"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2014-003087"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.3519"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.124.035797","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T09:43:44Z","timestamp":1728467024000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.124.035797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":52,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1161\/JAHA.124.035797"],"URL":"https:\/\/doi.org\/10.1161\/jaha.124.035797","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]},"assertion":[{"value":"2024-03-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e035797"}}