The Evolution of the Financial Delivery of Endovascular Aneurysm Repair in Contemporary Practice

Abstract

Previous work documented the fiscal impact of device cost compared with reimbursement associated with endovascular aneurysm repair (EVAR) delivery at an academic institution. The Centers for Medicare and Medicaid Services have since reclassified EVAR with a new Medicare Severity Diagnosis Related Group and increased reimbursement. We sought to compare the cost and revenue associated with EVAR before and after this change. All infrarenal EVARs performed in fiscal year (FY) 2017 were identified using the new diagnosis-related group (DRG) code 269 (n = 81). We then identified those who were treated according to the instructions for use guidelines with a single manufacturer's device and billed to Medicare (n = 13). From this cohort, we obtained total expenses with itemized costs, net revenue, and net margin from the hospital finance department. Results were then compared with previous values from a similar EVAR cohort in FY 2012 before the Centers for Medicare and Medicaid Services changes. The two cohorts had similar demographics and length of stay (age, 71 vs 75 years; 85% vs 82% male; mean length of stay, 1.4 vs 1.7 days in FY 2017 vs FY 2012 cohorts). Mean total expenses from the FY 2017 cohort was similar to those of the FY 2012 cohort ($33,118 vs $31,672). Graft implants continued to account for a significant portion of the total cost, with the device cost accounting for 40% of the total cost in the FY 2017 group compared with 52% in the FY 2012 group. Net revenue was higher in the FY 2017 group by $11,189 ($39,685 vs $27,657), resulting in higher overall margin in the FY 2017 group compared with the FY 2012 group ($6567 vs −$4015; Fig). Device costs continue to be the single greatest cost driver associated with EVAR delivery. DRG reclassification of EVAR to address procedure and implant costs should permit fiscal sustainability for institutions. Surgeons should continue to play an active role in EVAR care delivery and negotiate competitive device pricing to reflect EVAR-reclassified DRG reimbursement rates.