Udai S Sibia, MD, MBA, Justin J Turcotte, MBA, John R Klune, MD, MBA, Glen R Gibson, MD, FACS. Anne Arundel Medical Center
Introduction: The Centers for Medicare & Medicaid Services (CMS) recently announced new voluntary episode payment models for major bowel surgery that aim to align incentives across participating healthcare providers in an attempt to reduce healthcare costs and improve the overall quality of care. The purpose of this study was to examine the financial impact of bundled payments for major bowel surgery.
Methods: This was a case-series of all patients who underwent major bowel surgery from July 2016 through June 2018. Procedures were categorized using Medicare Severity Diagnosis Related Group (MS-DRG) coding which classifies patients into groups based on pre-existing comorbidity: patients without comorbidity (WOC; n=217), with comorbidity (WC; n=410), and with major comorbidity (MC; n=171). The primary endpoint of the study was hospital costs for the index admission, the rate of 30-day readmissions and the corresponding hospital costs for those readmissions. We assumed the median reimbursement in a fee-for-service model to be the bundled payment for the entire episode of care which included 30-day readmissions.
Results: A total of 700 patients underwent 798 procedures, with mean age 62.1 years and mean BMI 29.2 kg/m2. 54% were female. Percentage of patients with an ASA score >2 were as follows: 30.0% for WOC, 53.4% for WC, and 75.4% for MC. Forty-seven (6.7%) patients required a total of 53 reoperations during the initial index admission. The median length of stay, median hospital costs of the index admission, and 30-day readmissions rate were substantially lower for patients WOC (2.0 days; $10,766; 6.0%) compared to those WC (4.0 days; $14,370; 11.4%) and to those with MC (13.0 days; $28,162; 13.4%). Overall, 76 patients were readmitted 103 times for a total cost of $395,362. In our current fee-for-service reimbursement model, net hospital margins were 0.9% for WOC, -5.2% for WC, and -12.4% for MC. In a potential bundled payment reimbursement model where hospital readmissions would not be reimbursed, net hospital margins would decrease to -2.9% for WOC, -16.7% for WC, and -9.9% for MC.
Conclusions: Patients undergoing major bowel surgery are often a heterogeneous population with varied pre-existing comorbid conditions. These patients require a high level of complex care and hence greater hospital resources which can have a tremendous impact on hospital costs. As CMS continues to test alternative bundled payments, health systems must aim to minimize costs without compromising quality of care. This will continue to be a challenge as our population ages.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93572
Program Number: P362
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster