Episode-based Payment Variation for Urologic Cancer Surgery.

Area of Science:

• Urologic Oncology
• Health Services Research
• Healthcare Economics

Background:

• Significant financial variation exists in urologic cancer surgery payments.
• Understanding these payment disparities is crucial for healthcare reform.

Purpose of the Study:

• To investigate payment variations for 3 common urologic cancer surgeries.
• To evaluate the feasibility of bundled payment programs for these procedures.

Main Methods:

• Analysis of 2008-2011 SEER-Medicare linked data for patients >65 years.
• Calculation of total 90-day episode payments for cystectomy, prostatectomy, and nephrectomy.
• Comparison of hospital-level payment variation and its drivers.

Main Results:

• Wide payment variation observed for all 3 procedures (cystectomy, prostatectomy, nephrectomy).
• Index hospitalization and post-acute care drove variation for cystectomy/nephrectomy.
• Professional payments were the primary driver for prostatectomy payment variation.

Conclusions:

• Ninety-day episode payments for urologic cancer surgery exhibit substantial hospital-level variation.
• Key payment variation drivers are procedure- and hospital-specific.
• Individualized strategies are necessary for successful implementation of bundled payment models.