links.lww.com/MLR/C96

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Appendix 4. Hazard Ratios for TAVR Adoption, by Physician Group Practice Subgroup^a

Physician Group Practices With Prior Structural Heart Procedural Experience

Physician Group Practices With No Prior Structural Heart Procedural Experience

Coefficient Model 1: Market Characteristics

Model 2: Market

& Practice Characteristics

Model 3:

Market, Practice &

County Characteristics

Model 1: Market Characteristics

Model 2: Market

Model 3: Market, Practice & County Characteristics

Market Characteristics Population (log

change)

1.85 (1.12, 3.05)*

1.04 (0.60, 1.81)

0.75 (0.40, 1.39)

2.77

(1.64, 4.70)***

2.15

(1.24, 3.73)**

2.35

(1.26, 4.42)**

Physician group practice HHI^b

1.17 (1.00, 1.38)

1.19 (1.01, 1.41)*

1.19 (0.99, 1.44)

1.20

(1.09, 1.32)***

1.21

(1.10, 1.33)***

1.21

(1.09, 1.34)**

Hospital HHI^b 0.81

(0.71, 0.93)**

0.84

(0.73, 0.98)**

0.85 (0.71, 1.00)

0.89

(0.82, 0.96)**

0.90 (0.83, 0.99)*

0.97 (0.87, 1.07) Practice Characteristics

Mean HCC risk^c 0.83

(0.57, 1.20)

0.75 (0.49, 1.15)

0.95 (0.75, 1.19)

1.05 (0.83, 1.33)

Case volume 1.00

(0.99, 1.02)

1.01 (0.99, 1.02)

1.02

(1.02, 1.03)***

1.03

(1.02, 1.03)***

Academic hospital affiliation

2.00

(1.34, 2.99)**

1.64 (1.08, 2.51)*

3.38

(2.56, 4.48)***

2.80

(2.10, 3.73)***

TAVR hospital affiliation^d

18.6

(6.8, 51.1)***

20.2

(6.8, 59.8)***

8.0

(3.5, 18.2)***

7.3

(3.0, 17.3)***

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Physician Group Practices With Prior Structural Heart Procedural Experience

Physician Group Practices With No Prior Structural Heart Procedural Experience

Model 2: Market

Model 3:

Model 2: Market

Model 3: Market, Practice & County Characteristics

County Characteristics Medicare

managed care penetration^e

1.02 (0.89, 1.18)

1.32

(1.18, 1.47)***

Percentage change in managed care penetration^f

1.79 (0.74, 4.31)

1.72 (0.97, 3.03)

Urban county^g 2.61

(0.79, 8.66)

1.13 (0.41, 3.08) Per capita income

($thousands)

0.99 (0.98, 1.01)

1.00 (0.99, 1.01) Persons over age

65 (%)

1.00 (0.93, 1.08)

0.96 (0.92, 1.00) Adults with a

high school diploma (%)^h

0.99 (0.71, 1.38)

1.91

(1.48, 2.47)***

Physicians per capita

1.01 (1.00, 1.02)

1.00 (0.99, 1.01)

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Physician Group Practices With Prior Structural Heart Procedural Experience

Physician Group Practices With No Prior Structural Heart Procedural Experience

Model 2: Market

Model 3:

Model 2: Market

Model 3: Market, Practice & County Characteristics

Hospital beds per capita

0.999

(0.984, 1.014)

1.001

(0.998, 1.003) Coronary care

unit hospital in county

3.30 (1.11, 9.77)*

2.47

(1.45, 4.22)***

*p<0.05, **p<0.01, ***p<0.001

a Data presented are hazard ratio for unit change in characteristic, with 95% confidence interval in parentheses.

b Coded such that a unit change in the coefficient corresponds to a 1,000 difference in HHI.

c Mean HCC Risk among all Medicare patients receiving treatment by interventional cardiologists in the physician group practice

d Physician group affiliated with hospitals that participated in pre-FDA-approval TAVR clinical trials.

e Coded such that a unit change corresponds to a 10 percentage point difference in managed care penetration.

f Percentage point change in Medicare managed care penetration from 2011 to 2014 at the county level, coded such that a unit change corresponds to a 10 percentage point change in managed care penetration.

g Urban counties indicated by being coded as a "1" on the 2013 U.S. Department of Agriculture's Rural-Urban Continuum Coding Scheme (range 1-9).

h Percentage of adults over age 25 in the county with a high school diploma according the American Community Survey (2011). A unit change reflects a 10 percentage point change in the percentage of adults with a high school diploma.

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Abbreviations: HCC = Centers for Medicare and Medicaid Services Hierarchical Condition Category; TAVR = Transcatheter Aortic Valve Replacement; HHI = Hirfindahl-Hirschman Index; CCU = Coronary Care Unit