Simulating Episode-Based Bundled Payments for Cranial Neurosurgical Procedures

Area of Science:

• Neurosurgery
• Health Economics
• Healthcare Policy

Background:

• Medicare introduced episode-based bundled payments (Bundled Payments for Care Improvement - BPCI) in 2013 to enhance care coordination and cost efficiency.
• BPCI has not yet been implemented for cranial neurosurgical procedures.

Purpose of the Study:

• To project the financial values of episode-based bundled payments for common cranial neurosurgical procedures.
• To analyze cost drivers and variability in projected payments using retrospective data.

Main Methods:

• A retrospective observational study was conducted using the MarketScan administrative database.
• Four groups of common cranial neurosurgical procedures were analyzed to project 30- and 90-day bundled payments.
• 15,276 procedures meeting inclusion criteria were identified.

Main Results:

• Projected 90-day bundled payments varied significantly, from $58,200 (craniotomy for meningioma) to $102,073 (craniotomy for malignant glioma).
• Index hospitalization comprised 85% of 30-day and 70.5% of 90-day projected bundle payments.
• Factors like readmissions, post-acute care, VTE, comorbidities, adjuvant therapies, and payer status significantly influenced projected cranial bundle payments.

Conclusions:

• This study provides the first projections of episode-based bundled payments for cranial neurosurgery.
• Significant payment variability exists within cranial procedures, similar to orthopedics.
• Post-discharge care plays a more critical role in total bundle payments for cranial neurosurgery compared to spine and orthopedic procedures.