P135. Patient specific risk factors for reduced profitability of a private insurance bundled payment model for lumbar fusion and decompression

Abstract

<h3>BACKGROUND CONTEXT</h3> Health care reimbursements have started to shift from fee-for-service to bundled payments. Given this trend, there is a need to assess the performance of bundled reimbursement models and adjust target costs appropriately. <h3>PURPOSE</h3> The purpose of this study is to evaluate how patient demographics, individual medical comorbidities and surgical variables affect the net profits or losses for care episodes in a private insurance bundled payment model. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> A consecutive series of primary and revision thoracolumbar fusion and decompression care episodes were retrospectively reviewed at a single academic institution from 2018-2019 using bundled payment claims data from two private insurers. <h3>OUTCOME MEASURES</h3> Net profits or losses per care episode. <h3>METHODS</h3> Patients were divided into cohorts based on the net profit or loss at the end of each episode, which was calculated from target costs set by the historical performance of the bundle. Patient demographics, individual medical comorbidities and clinical outcomes were collected for all patients. Stepwise multivariate logistic regression models were developed to measure the effect of patient demographics and medical comorbidities on the likelihood of a care episode resulting in a net loss. Pvalues < 0.05 were considered statistically significant. <h3>RESULTS</h3> A total of 325 lumbar fusions and/or decompressions were included in the analysis (177 fusions: 98 profits, 79 losses; 148 decompressions: 99 profits, 49 losses). For fusion episodes, the average net profit was $17,687 for profitable procedures compared to $-34,211 for nonprofitable procedures (p < 0.001). Among patients who underwent fusion, cardiac arrhythmias (OR=3.20, p=0.047) and an increased number of levels fused (OR=1.58, p=0.031) significantly increased the likelihood of a care episode resulting in a loss. For decompression episodes, the average net profit was $3,035 for profitable procedures compared to $-9,532 for nonprofitable procedures (p < 0.001). Among patients who underwent decompression, hypertension (OR=2.60, p=0.038), hypercholesterolemia (OR=3.14, p=0.015), and an increased number of levels decompressed (OR=5.15, p < 0.001) significantly increased the likelihood of a care episode resulting in a loss. <h3>CONCLUSIONS</h3> Surgeons should understand how medical comorbidities, including arrhythmias, hypertension and hypercholesterolemia, may impact total episode of care target prices in a private insurance bundled payment model. Further study is required to determine if target costs in bundled payment models need to be adjusted to appropriately compensate for certain medical comorbidities. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.