Drivers of Payment Variation in 90-Day Coronary Artery Bypass Grafting Episodes

Guduguntla, Vinay; Syrjamaki, John; Ellimoottil, Chad; Miller, David C.; Prager, Richard L.; Norton, Edward C.; Theurer, Patricia F.; Likosky, Donald S.; Dupree, James M.

doi:10.1001/jamasurg.2017.2881

Cited by 51 publications

(43 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Increased readmission rates have been linked to poorer hospital performance and, among patients undergoing coronary artery bypass grafting (CABG), increased 30‐day mortality . CABG patients with multiple readmissions have also been shown to be significant drivers of cost variation over 90‐day episodes of care . Given the high volume and cost of CABG in an increasingly high‐risk patient population, policymakers have developed readmission reduction programs and other reimbursement reforms to achieve value‐oriented health care goals .…”

Section: Introductionmentioning

confidence: 99%

“…patients with multiple readmissions have also been shown to be significant drivers of cost variation over 90-day episodes of care. 4 Given the high volume and cost of CABG in an increasingly high-risk patient population, policymakers have developed readmission reduction programs and other reimbursement reforms to achieve valueoriented health care goals. 5 These programs have generated renewed interest in clinicians' longstanding efforts to prevent costly and potentially harmful readmissions following cardiac surgery.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

et al. 2019

View full text Add to dashboard Cite

Background Readmissions after cardiac surgery are common and associated with increased morbidity, mortality and cost of care. Policymakers have targeted coronary artery bypass grafting to achieve value‐oriented health care milestones. We explored the causes of readmission following cardiac surgery among a regional consortium of hospitals. Methods Using administrative data, we identified patients readmitted to the same institution within 30 days of cardiac surgery. We performed standardized review of readmitted patients’ medical records to identify primary and secondary causes of readmission. We evaluated causes of readmission by procedure and tested for univariate associations between characteristics of readmitted patients and nonreadmitted patients in our clinical registry. Results Of 2218 cardiac surgery patients, 272 were readmitted to the index hospital within 30 days for a readmission rate of 12.3%. Median time to readmission was 9 days (interquartile range 4‐16 days) and only 13% of patients were evaluated in‐office before readmission. Readmitted patients were more likely to have had valve surgery (31.3% vs 22.7%) than patients not readmitted. Readmitted patients were also more likely to have preoperative creatinine more than or equal to 2 mg/dL (P = .015) or congestive heart failure (CHF) (P = .034), require multiple blood transfusions or sustained inotropic support (P < .001), and experience postoperative atrial fibrillation (P = .022) or renal insufficiency (P < .001). Infection (26%), pleural or pericardial effusion (19%), arrhythmia (16%), and CHF (11%) were the most common primary etiologies leading to readmission. Conclusions Ensuring early follow‐up for high‐risk patient groups while improving early detection and management of the principal drivers of readmission represent promising targets for decreasing readmission rates.

show abstract

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

et al. 2019

View full text Add to dashboard Cite

show abstract

“…MVC developed and maintains a validated claims-based registry with 90-day price-standardized episodes of care from Medicare fee-for-service and Blue Cross Blue Shield of Michigan preferred provider organization administrative claims. 13–15, 18 All clinically-related claims within 90 days after discharge from the index hospitalization or procedure were included in the episode. This use of a 90-day window is consistent with the design of recent bundled payment initiatives.…”

Section: Methodsmentioning

confidence: 99%

“…The total risk-adjusted episode payment was then disaggregated into 4 principal payment components: index hospitalization/procedure, professional fees, post-acute care, and readmissions. 13–15…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Drivers of Variation in 90-Day Episode Payments After Percutaneous Coronary Intervention

Sukul

Seth

Dupree

et al. 2019

Circ: Cardiovascular Interventions

Self Cite

View full text Add to dashboard Cite

Background: Percutaneous coronary intervention (PCI) is a common and expensive procedure that has become a target for bundled payment initiatives. We described the magnitude and determinants of variation in 90-day PCI episode payments across a diverse array of patients and hospitals. Methods and Results: We linked clinical registry data from PCIs performed at 33 Michigan hospitals to 90-day episodes of care constructed using Medicare fee-for-service and commercial insurance claims from 1/2012-10/2016. Payments were price-standardized and risk-adjusted using clinical and administrative variables in an observed-over-expected framework. Hospitals were stratified into quartiles based on average episode payments. Payment components between the highest and lowest quartiles were compared to identify drivers of variation (i.e. index hospitalization/procedure, readmissions, post-acute care, professional fees). Among 40,925 90-day PCI episodes, the average risk-adjusted 90-day episode payment by hospital ranged between $22,154 and $27,205 with a median of $24,696 (IQR: $24,190-$25,643). Hospitals in the lowest and highest quartiles had average episode payments of $23,744 and $26,504, respectively (difference: $2,760). Readmission payments were the primary driver of this variation (46.2%), followed by post-acute care (22.6%). Readmissions remained the primary driver of variation in key subgroups including inpatient and outpatient PCI, as well as PCI for acute myocardial infarction (AMI) and non-AMI indications. Conclusions: Substantial hospital-level variation exists in 90-day PCI episode payments. Over half the variation between high and low payment hospitals was related to care after the index procedure, primarily due to readmissions and post-acute care. Hospitals and policymakers should consider targeting these components when developing initiatives to reduce PCI-related spending.

show abstract

Episode Payment Model for Coronary Artery Bypass Grafting—Opportunities and Challenges

2018

View full text Add to dashboard Cite

Drivers of Payment Variation in 90-Day Coronary Artery Bypass Grafting Episodes

Cited by 51 publications

References 17 publications

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

Drivers of Variation in 90-Day Episode Payments After Percutaneous Coronary Intervention

Episode Payment Model for Coronary Artery Bypass Grafting—Opportunities and Challenges

Contact Info

Product

Resources

About