For-profit hospitals deliver lower coronary artery bypass graft value: National evidence on mortality and Medicare expenditures.

Abstract

Regional variation in the fiscal value of coronary artery bypass grafting procedures persists across the United States. This study determines whether these disparities are associated with state-level economic factors or foundational hospital characteristics. We hypothesized that hospital ownership (for-profit vs nonprofit) and teaching status are significantly associated with mortality and postdischarge spending, independent of regional economic health. We analyzed 776 US hospitals using 2021-2024 Centers for Medicare & Medicaid Services data for 30-day coronary artery bypass graft-related mortality and 2023 data for postdischarge spending. Hospital ownership and teaching status (academic vs nonacademic) were extracted from the fiscal year 2025 Inpatient Prospective Payment System Impact File. Local economic context was established using 2023 county-level personal income. Associations were assessed using multivariable ordinary least squares regression. After multivariable adjustment, county-level income independently predicted lower mortality (P < .001), but had a minor association with spending (-$43 per $10,000; P = .037). Conversely, for-profit ownership independently predicted higher spending (+$409; P < .001) without a corresponding mortality benefit (P = .524). Academic teaching status independently predicted reduced mortality (-0.21 percentage points; P = .005) without cost spikes. National disparities in coronary artery bypass grafting value were not explained by regional economic conditions but were associated with hospital ownership and teaching status. Hospital structure determined value: For-profit hospitals demonstrated higher mortality and spending, whereas academic centers achieved lower mortality with only a modest spending increase.