90-Day Bundled Payment Simulation, Health Care Utilization, and Complications following Craniopharyngioma Resection in Adult Patients

Abstract Context Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown. Objective This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection. Design This study is presented as a retrospective cohort analysis (2000–2016) with 2 years of follow-up. Setting The study included national inpatient hospitalization and outpatient visits. Patients Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC). Interventions This study investigated transphenoidal or subfrontal approach for tumor resection. Main Outcome Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study. Results Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; p < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; p < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; p < 0.0001). Conclusion ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection.

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Bundle Payment, Health Care Utilization, and Outcomes Following Surgery for Anterior, Middle, and Posterior Cranial Fossa Skull Base Meningioma: A Market Scan Analysis

Neurosurgery ◽

10.1093/neuros/nyz310_162 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Mayur Sharma ◽

Beatrice Ugiliweneza ◽

Maxwell Boakye ◽

Norberto O Andaluz ◽

Brian J Williams

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Hospital Stay ◽

Complication Rate ◽

The United States ◽

Posterior Cranial Fossa ◽

Care Utilization ◽

Outpatient Services ◽

Significant Difference ◽

Cranial Fossa

Abstract INTRODUCTION Meningioma is the most common benign intracranial brain tumor accounting for approximately one-third of all primary brain tumors. The aim of our study was to compare the bundle payment, health care utilization, and outcomes following surgery for anterior (AFM), middle (MFM), and posterior cranial fossa meningioma (PFM) across the United States. METHODS We queried the Market Scan database using ICD-9 and CPT-4, from 2000 to 2016. We included adult patients who had at least 24 mo of enrollment following the surgical procedure. The outcome of interest was length of hospital stay, disposition, complications, and reoperation following the procedure. RESULTS A cohort of 1,188 patients was identified from the database. In all 43.86% of tumors were AFM, 32.32% were MFM, and only 23.8% were PFM. Patients who underwent surgery for PFM had significant longer hospital stay (P = .0013), higher complication rate (P = .0009), and less likely to be discharged home (P = .0013) during index hospitalization. Patients with MFM and PFM incurred higher outpatient services with no differences in corresponding payments compared to those with AFM at 12 mo (P < .0001) and 24 mo follow-up (P < .0001). There were no differences in overall payments at 12 mo (AFM: $19,702; MFM: $20,671; PFM: $20,922) and 24 mos (AFM: $37,142; MFM: $44,133; PFM: $36,601) among the cohorts. There was no significant difference in 90-d median bundle payments among the groups, $66,173 (AFM) vs $65,602 (MFM), and $71,837 (PFM), P = .1955. CONCLUSION Ninety-day bundle payment and overall payments (at 12 mo and 24 mo) were not significantly different among the cohorts. Patients with PFM had longer hospital stay, higher complication rate, and less likely to be discharged home with higher utilization of outpatient services at 12 mo and 24 mo.

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Medicare’s Bundled Payment Program and Health Care Utilization

JAMA ◽

10.1001/jama.2016.3815 ◽

2016 ◽

Vol 315 (22) ◽

pp. 2470

Author(s):

William B. Weeks

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Care Utilization ◽

Bundled Payment

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Association of SHI coverage and level of healthcare utilization and costs in the Philippines: a 10-year pooled analysis

Journal of Public Health ◽

10.1093/pubmed/fdz142 ◽

2019 ◽

Vol 42 (4) ◽

pp. e496-e505

Author(s):

Nel Jason L Haw ◽

Jhanna Uy ◽

Beverly Lorraine Ho

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Utilization ◽

Health Care Costs ◽

Inpatient Care ◽

The Philippines ◽

Care Utilization ◽

Health Coverage ◽

Outpatient Services ◽

Care Costs

Abstract Background The Philippine Health Insurance Corporation (PhilHealth), which manages the Philippine national health insurance program, is a critical actor in the country’s strategy for universal health coverage. Over the past decade, PhilHealth has passed significant coverage, benefits and payment reforms to contain costs and improve the affordability care for high-cost diseases, inpatient care and select outpatient services. Methods We studied the association of PhilHealth with health care utilization and health care costs using three rounds of the Philippine Demographic and Health Survey with data on individual outpatient and inpatient visits from 2008 to 2017. Results PhilHealth membership was associated with 42% greater odds of outpatient utilization and 47–100% greater odds inpatient utilization depending on survey year. Depending on facility type, use of PhilHealth to pay for care was associated with higher average health care costs of 244–865% for outpatient care and 135–206% for inpatient care. Conclusions PhilHealth has likely decreased barriers to health care utilization but may have inadvertently driven up health care costs in the country. Results align with past studies that suggest that reforms in the prior decade have done little to contain health care costs for Filipinos.

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Health Care Utilization in Patients Undergoing Repeat Stereotactic Radiosurgery for Vestibular Schwannoma with 5-Year Follow-up: A National Database Analysis

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1716672 ◽

2020 ◽

Author(s):

Nicholas Dietz ◽

Mayur Sharma ◽

Beatrice Ugiliweneza ◽

Dengzhi Wang ◽

Maxwell Boakye ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Stereotactic Radiosurgery ◽

Vestibular Schwannoma ◽

Hospital Admissions ◽

International Classification Of Diseases ◽

National Database ◽

Care Utilization ◽

Outpatient Services

Abstract Background Stereotactic radiosurgery (SRS) has been used as an alternative to microsurgery in patients with small vestibular schwannoma (VS). We compare health care utilization metrics in patients undergoing repeat-SRS (re-SRS) and no repeat SRS (nr-SRS) at long-term follow-up. Materials and Methods We queried the MarketScan database using International Classification of Diseases, Ninth Revision and Current Procedural Terminology 4, from 2000 to 2016. We included adult patients who had diagnosis of VS and treatment with SRS with at least 5 years of continuous enrollment after the procedure. Outcomes were hospital admissions, outpatient services, and medication refills. Results Of 1,047 patients, 5.1% (n = 53) had repeat SRS. Majority of re-SRS (74%, n = 39) were done within 2 years of index procedure and 51% were within 1-year of initial procedure. Patients who required re-SRS incurred higher hospital readmission rate, outpatient services, and had higher payments compared with those who did not require re-SRS at 6 months, 1 year, and 2 years following the initial procedures. Re-SRS received 3.0- and 3.1-times higher payments at 1 and 2 years compared with nr-SRS cohort. At 5 years following SRS, median combined payments for re-SRS cohort was $105286 (interquartile range [IQR] $70999, $156569) compared with $44172 (IQR $22956, $84840) for nr-SRS cohort. Conclusion More than half of the re-SRS procedures were noted within first year of initial SRS for VS. Overall payments at 5 years for repeat SRS was more than double that for nr-SRS. Repeat SRS was also associated with more re-admissions and outpatient services at annual follow-up time points.

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Health care utilization in persons with spinal cord injury: part 1—outpatient services

Spinal Cord ◽

10.1038/sc.2017.44 ◽

2017 ◽

Vol 55 (9) ◽

pp. 823-827 ◽

Cited By ~ 9

Author(s):

A Gemperli ◽

◽

E Ronca ◽

A Scheel-Sailer ◽

H G Koch ◽

...

Keyword(s):

Health Care ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Health Care Utilization ◽

Care Utilization ◽

Outpatient Services ◽

Cord Injury

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Medicare’s Bundled Payment Program and Health Care Utilization—Reply

JAMA ◽

10.1001/jama.2016.3823 ◽

2016 ◽

Vol 315 (22) ◽

pp. 2471

Author(s):

Matthew J. Press ◽

Rahul Rajkumar ◽

Patrick H. Conway

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Care Utilization ◽

Bundled Payment

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A retrospective, observational cohort analysis of a nationwide database to compare heart failure prescriptions and related health care utilization before and after publication of updated treatment guidelines in the United States

Clinical Therapeutics ◽

10.1016/j.clinthera.2010.08.002 ◽

2010 ◽

Vol 32 (9) ◽

pp. 1642-1650 ◽

Cited By ~ 10

Author(s):

Shirin Shafazand ◽

Yadong Yang ◽

Elizabeth Amore ◽

Welton O’Neal ◽

Diana Brixner

Keyword(s):

United States ◽

Heart Failure ◽

Health Care ◽

Health Care Utilization ◽

Treatment Guidelines ◽

Cohort Analysis ◽

The United States ◽

Care Utilization ◽

Before And After ◽

Observational Cohort

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Health Care Utilization Following Inpatient Femoropopliteal Revascularization With Drug-Coated Balloon Angioplasty: A Nationwide Cohort Analysis

Journal of Endovascular Therapy ◽

10.1177/1526602820984111 ◽

2021 ◽

pp. 152660282098411

Author(s):

Michael I. Gurin ◽

Sebastian E. Beyer ◽

Mitchell Weinberg ◽

Sahil A. Parikh ◽

Ehrin J. Armstrong ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Balloon Angioplasty ◽

Cohort Analysis ◽

Treatment Strategies ◽

Care Utilization ◽

Logistic Regression Models ◽

Hospitalization Costs ◽

Artery Disease ◽

Adjusted Logistic Regression

Purpose To examine nationwide variations in inpatient use of drug-coated balloons (DCBs) for treating femoropopliteal segment occlusive disease and whether DCBs are associated with reduced early out-of-hospital health care utilization. Materials and Methods The study included 24,022 patients who survived hospitalization for femoropopliteal revascularization using DCB angioplasty (n=7850) or uncoated balloon angioplasty (n=16,172) in the 2016–2017 Nationwide Readmissions Database. Differences in patient, hospitalization, and institutional characteristics were compared between treatment strategies. Adjusted logistic regression models were used to examine differences in 6-month rates of readmission, amputation, and repeat intervention. Results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results Patients treated with DCBs had a higher prevalence of chronic limb-threatening ischemia, diabetes, hypertension, and tobacco use. Revascularization with a DCB was associated with shorter hospitalizations, lower median hospitalization costs, and fewer inpatient lower extremity amputations. Readmissions at 6 months were decreased in patients treated with DCBs compared with uncoated balloon angioplasty (OR 0.90, 95% CI 0.83 to 0.98, p=0.014). The most common reasons for readmission were complications related to procedures (15.4%) and diabetes (15.4%). Compared to patients treated with DCBs, patients treated with uncoated balloon angioplasty were more often readmitted with early procedure-related complications (13.3% vs 17.5%). There were no between-group differences in readmission for sepsis, myocardial infarction, or congestive heart failure. Conclusion DCBs are less often used compared to uncoated balloons during inpatient femoropopliteal procedures. While DCB utilization is associated with more severe comorbidities and advanced peripheral artery disease, readmission rates are decreased through the first 6 months.

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