Are we ready for bundled payments for major bowel surgery?
- PDF / 740,546 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 84 Downloads / 327 Views
and Other Interventional Techniques
Are we ready for bundled payments for major bowel surgery? Udai S. Sibia1 · Justin J. Turcotte1 · John R. Klune1 · Glen R. Gibson1 Received: 25 February 2019 / Accepted: 28 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background The Centers for Medicare & Medicaid Services (CMS) recently announced a new voluntary episode payment model for major bowel surgery. The purpose of this study was to examine the financial impact of bundled payments for major bowel surgery. Methods An institutional database was retrospectively queried for all patients who underwent major bowel surgery between July 2016 and June 2018. Procedures were categorized using MS-DRG coding: MS-DRG 329 (with MCC, major complications and comorbidity), MS-DRG 330 (with CC, complications and comorbidity), and MS-DRG 331 (without CC/MCC). Results A total of 745 patients underwent 798 procedures, with mean age 62.1 years and BMI 29.2 kg/m2. The median LOS was 4.0 days, with 12.5% of patients being discharged to a post-acute care facility for an average of 38.5 days. The mean hospital cost was $18,525. The mean payment to a post-acute care facility was $423 per day. The 90-day readmission rate was 8.6% at an average cost of $12,859 per readmission. Patients with major complications and comorbidity (MS-DRG 329) had higher CMS Hierarchical Condition Categories scores, longer LOS, higher costs, more required home health services or post-acute care facilities, and had higher 90-day readmissions. In a fee-for-service model, hospital reimbursements resulted in a negative margin of − 8.2% for MS-DRG 329, − 2.6% for MS-DRG 330, but a positive margin of 2.8% for MS-DRG 331. In a bundled payment model, the hospital would incur a loss of − 13.1%, − 11.1%, and − 1.9% for MS-DRG 329, 330, and 331, respectively. Conclusions Patients undergoing major bowel surgery are often a heterogeneous population with varied pre-existing comorbid conditions who require a high level of complex care and utilize greater hospital resources. Further study is needed to identify areas of cost containment without compromising the overall quality of care. Keywords Bundled payments · Hospital costs · Readmissions · Major bowel surgery · Post-acute care facility Healthcare spending in the United States is projected to increase to 19.7% of GDP by 2026 [1]. In 2010, the affordable care act (ACA) was passed with an aim to reduce national healthcare spending and improve the overall quality of care [2]. In response to the ACA, the Center for Medicare and Medicaid Innovation created the Bundled payments for care improvement (BPCI) initiative and introduced bundled payments as an alternative payment model for hospitals. The BPCI is composed of four models of care [3]. Model 1 makes a retrospective payment for all inpatient services, This abstract was an e-poster presentation at the 2019 SAGES meeting in Baltimore, Maryland. * Udai S. Sibia [email protected] 1
except professional fees which are reimbursed sepa
Data Loading...
