Early Impact of Medicare Accountable Care Organizations on Inpatient Surgical Spending

Nathan, Hari; Thumma, Jyothi R.; Ryan, Andrew M.; Dimick, Justin B.

doi:10.1097/sla.0000000000002819

Cited by 30 publications

(25 citation statements)

References 32 publications

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“…Mortality, defined as patient death occurring greater than 30 days from the index operation, was obtained from the SAF Denominator file . Inpatient, outpatient, and hospice expenditures were price standardized and adjusted by wage index, Disproportionate Share Hospital and Indirect Medical Education . Patient contributions were not included in this tabulation.…”

Section: Methodsmentioning

confidence: 99%

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Paredes

Hyer

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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Background: Use of hospice services among patients with pancreatic cancer following pancreatic resection remains unknown. Methods: Patients with pancreatic cancer who underwent resection were identified in the Medicare Standard Analytic Files. Outcomes included overall hospice use, early hospice enrollment (≥4 weeks before death), late hospice enrollment (initiation within 3 days of death), and Medicare expenditures. Results: Among the 4369 deceased individuals, three-fourths of patients (n = 3252, 74.4%) used hospice at the time of death. Patients who did not use hospice were more likely to be male, have a complication on index admission and receive life sustaining treatments on subsequent admissions (P < .05). Only one-third (32.2%) of patients initiated hospice services early. Medicare expenditure during the last month of life was $10 000 lower among patients who initialized hospice services at least 1 month before death versus within 3 days of death (late: $10 581 [$5454-$17 200], early: $221 [$46-$733]; P < .001) Conclusion: While three-fourths of patients utilized hospice services after pancreatic resection, only one-third of patients initiated hospice services at least one-month before death. Late hospice use was associated with higher Medicare expenditures during the last month of life. Further research is needed to understand barriers to early hospice utilization.

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Section: Methodsmentioning

confidence: 99%

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Paredes

Hyer

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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“…This methodology allowed us to evaluate the impact of the CPG on hospital costs at active sites, taking into account cost trends during the study period at the control sites. This approach has been used across several fields to examine a number of outcomes before and after the implementation of various policies or initiatives [9, 12, 13]. …”

Section: Methodsmentioning

confidence: 99%

Hospital Costs Related to Early Extubation After Infant Cardiac Surgery

McHugh

Mahle

Hall

et al. 2019

The Annals of Thoracic Surgery

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Background The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation rates after infant tetralogy of Fallot (TOF) and coarctation of the aorta (CoA) repair across participating sites by implementing a clinical practice guideline (CPG). The impact of the CPG on hospital costs has not been studied. Methods PHN CLS clinical data were linked to cost data from Children’s Hospital Association by matching on indirect identifiers. Hospital costs were evaluated across active and control sites in the pre- and post-CPG periods using generalized linear mixed-effects models. A difference-in-difference approach was used to assess whether changes in cost observed in active sites were beyond secular trends in control sites. Results Data were successfully linked on 410 of 428 eligible patients (96%) from four active and four control sites. Mean adjusted cost per case for TOF repair was significantly reduced in the post-CPG period at active sites ($42,833 vs $56,304, p < 0.01) and unchanged at control sites ($47,007 vs $46,476, p = 0.91), with an overall cost reduction of 27% in active versus control sites (p = 0.03). Specific categories of cost reduced in the TOF cohort included clinical (−66%, p < 0.01), pharmacy (−46%, p = 0.04), lab (−44%, p < 0.01), and imaging (−32%, p < 0.01). There was no change in costs for CoA repair at active or control sites. Conclusions The early extubation CPG was associated with a reduction in hospital costs for infants undergoing repair of TOF but not CoA. This CPG represents an opportunity to both optimize clinical outcome and reduce costs for certain infant cardiac surgeries.

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“…Yet, surgeons continue to be underrepresented in the design and deployment of VBC models such as accountable care organizations, which in turn have been unable to move the needle on surgical costs. 2 , 3 Even for VBC initiatives targeting surgery – such as bundled payments – the changes in clinical practice have largely been downstream from surgical care (eg, post-acute referrals). 4…”

mentioning

confidence: 99%

“…Given that surgical care accounts for roughly 30% of total healthcare expenditures and 50% of inpatient spending, there is a clear need for future VBC reforms that meaningfully engage surgeons, and their collaborators in anesthesiology and nursing, to reduce costs and improve outcomes. 3 Adding to the impetus for change is the COVID-19 pandemic, which has exposed fundamental flaws in healthcare's operating model. The resulting regulatory reforms for service modality (eg, telemedicine), site of delivery (eg, hospital at home), and organization of payment (eg, pressure for site neutrality) have long-reaching implications for both improving value within procedures and better integrating surgical care into the larger care continuum.…”

mentioning

confidence: 99%