Abstract 16025: The Association of Cardiology Billing Patterns With Healthcare Utilization and Clinical Outcomes in Atrial Fibrillation Patients

Introduction: The relationship between health care utilization and clinical outcomes in patients (pts) with atrial fibrillation (AF) is unknown. The objective of this study was to investigate whether cardiologists’ billing patterns are associated with different patient-level clinical outcomes. Methods: A retrospective cohort study was conducted using claims data in Ontario, Canada between April 1, 2011 and March 31, 2016. This study included all cardiologists who had at least 25 AF pts per year, and whose billings were ≥80% fee-for service. The cardiologists were stratified into quintiles based on their median billing per patient over the study period. The primary outcomes were patient-level receipt of repeat visits, cardiac diagnostic tests, medications ≤1 year of index date. The secondary clinical outcomes were death, emergency department visits and all-cause hospitalization at 1 year post-index visit. Results: The patient cohort was comprised of 182,572 AF pts (median age 74 years, 58% male) from 467 cardiologists. AF pts seen by higher billing cardiologists were more likely to undergo diagnostic tests within the first year of the index visit. Pts were 26% more likely to have an echocardiogram (adjusted odds ratio [aOR] 1.26 [95% CI, 1.13 to 1.39]), 28% a stress test (aOR 1.28 [1.15-1.42]), 25% Holter monitoring (aOR 1.25 [1.10-1.40]), and 80% more likely to get a stress echocardiogram (aOR 1.80 [1.49-2.10]), highest vs quintile 2. (Figure). Pts across billing quintiles received similar medical therapy. AF pts seen by higher billing cardiologists had a higher rate of all-cause hospitalization (aOR 1.13 [1.07- 1.19]); mortality rates were similar across cardiologists billing quintiles (e.g., aOR 0.98 [0.91- 1.04] for quintile 4 vs 2). Conclusion: Cardiologists who bill more per patient tend to order more diagnostic tests per AF patient but these are not associated with lower rates of hospitalization or death.