Financial Overview of an LVAD Program under Global Bundled Payment Model

Abstract

Purpose LVADs decrease mortality but have high hospitalization costs. Maryland operates the nation's only global bundled payment (GBP) model with an all-payer system where insurers reimburse at similar rates. The financial impact on LVAD volume is unclear. We hypothesized that the GBP model would not financially limit LVAD program growth. Method We performed a retrospective review of LVAD patients at a single center. We analyzed direct variable charges relative to patients’ characteristics and lengths of stay (LOS). Charges were those incurred from index LVAD implant admission and readmissions. Results Between 12/15 and 8/17, 50 patients had LVAD implants, 45 had available data. Median age was 56 years, median support 150 days (IQ 92-275), and 77.4% had less than a college education. By 8/17, 26 (57.8%) remained on LVAD support, 13 (28.9%) were transplanted, and 5 died (11%). Most had government insurance that paid at 93% of charges (Figure A) with a payment:cost ratio > 1. Total charges are $17,753,728. LOS from implant to discharge was 16 days (IQ 12-28). Median charge of LVAD implant admission was $322,058. For each extra hospital day, charge increased by $5585 (R2 = 0.7348, p Conclusion The GBP model may not limit LVAD program growth given payment:cost ratio > 1 by non-commercial insurance. LVAD implant in less sick patients and reduced readmissions likely result in net positive income for a program under the GBP model.