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

  • 0Medical Student, School of Medicine, University of Michigan, Ann Arbor.
Jama Surgery +

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August 24, 2017

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August 24, 2017

View abstract on PubMed

Summary

This summary is machine-generated.

Ninety-day payments for coronary artery bypass grafting (CABG) surgery show significant variation among hospitals. Understanding these payment drivers is crucial for upcoming bundled payment programs in cardiac care.

Area Of Science

  • Health Economics
  • Cardiac Surgery
  • Health Policy

Background

  • Coronary artery bypass grafting (CABG) is transitioning to a mandatory Medicare bundled payment program.
  • Understanding 90-day CABG episode payments is vital for informing health policy and hospital strategies.
  • Variation in CABG payments impacts the potential effects of bundled payment models.

Purpose Of The Study

  • To examine the variation in 90-day episode payments for coronary artery bypass grafting (CABG).
  • To identify the key drivers contributing to payment variation in CABG episodes.

Main Methods

  • Retrospective cohort study using Medicare and private payer claims (Jan 2012-Oct 2015).
  • Calculated 90-day price-standardized, risk-adjusted total episode payments for CABG patients.
  • Compared payment components across hospitals categorized into quartiles by mean total episode payments.

Main Results

  • Significant variation in 90-day CABG episode payments was observed, ranging from $11,723 to $356,850 per patient.
  • Hospitals in the highest payment quartile had 16.4% higher mean total episode payments than those in the lowest quartile.
  • Drivers of variation included diagnosis-related group distribution, inpatient services, postacute care utilization, and readmissions.

Conclusions

  • Substantial variation exists in 90-day CABG episode payments for Medicare and private payer patients.
  • Hospitals and clinicians should analyze local payment variations, focusing on readmissions and post-discharge care.
  • Understanding these factors is essential for successful implementation of bundled payment programs for CABG.

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