PD14-01 VARIATION IN 90-DAY EPISODE PAYMENTS FOR UROLOGICAL CANCER SURGERY: IMPLICATIONS FOR BUNDLED PAYMENT PROGRAMS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures I1 Apr 2017PD14-01 VARIATION IN 90-DAY EPISODE PAYMENTS FOR UROLOGICAL CANCER SURGERY: IMPLICATIONS FOR BUNDLED PAYMENT PROGRAMS Jonathan Li, Zaojun Ye, Hye Sung Min, Deborah Kaye, Lindsey Herrel, James Dupree, David Miller, and Chad Ellimoottil Jonathan LiJonathan Li More articles by this author , Zaojun YeZaojun Ye More articles by this author , Hye Sung MinHye Sung Min More articles by this author , Deborah KayeDeborah Kaye More articles by this author , Lindsey HerrelLindsey Herrel More articles by this author , James DupreeJames Dupree More articles by this author , David MillerDavid Miller More articles by this author , and Chad EllimoottilChad Ellimoottil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.702AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aiming to reduce variation in spending for common surgical procedures, Medicare and other payers have moved toward alternative reimbursement models such as episode-based bundled payments. However, little is known about the variation in 90-day episode spending for urological cancer surgery. METHODS Using linked SEER-Medicare data, we identified a study cohort that included all Medicare beneficiaries who underwent cystectomy, prostatectomy, or nephrectomy for cancer from 2008 through 2011. We then calculated total episode payments by aggregating hospital, physician, and post-acute care claims from the index surgical hospitalization through 90 days post-discharge. Total payments were then compared to examine hospital level-variation within each procedure type. Next, we evaluated differences in hospital, physician, and post-acute care payments between the highest and lowest spending quartiles based on mean total episode payments. Finally, we assessed the ″payment signatures″ among the most expensive hospitals for each condition. RESULTS From 2008 through 2011, we identified 90-day episodes of care for 1,768 cystectomies, 8,755 prostatectomies, and 4,305 nephrectomies. We observed wide variation in mean episode payments for all three conditions (cystectomy mean $31,836: range $22,322 to $41,706, prostatectomy mean $9,580: range $7,535 to $15,694, nephrectomy mean $16,554: range $10,857 to $25,675). For cystectomy, payments for the index hospitalization represented 50.1% of the total cost variation, whereas for prostatectomy the primary driver was physician fees (34.6%), and for nephrectomy post-acute care costs varied the greatest (37.7%). Each of the most expensive hospitals demonstrated a unique signature for the payment component that was driving high total episode payments (Figure). CONCLUSIONS Ninety-day episode payments for urological cancer surgery vary widely across hospitals in the United States. The key drivers of payment variation differ for individual procedures and hospitals. Accordingly, hospitals will need individualized data and clinical re-design strategies to succeed with implementation of episode-based payment models for urological cancer care. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e276 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jonathan Li More articles by this author Zaojun Ye More articles by this author Hye Sung Min More articles by this author Deborah Kaye More articles by this author Lindsey Herrel More articles by this author James Dupree More articles by this author David Miller More articles by this author Chad Ellimoottil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...