Referral of Pediatric Moyamoya for Revascularization: Financial and Quality Data Supporting Private Insurer Approval for Out-of-Network Care
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View abstract on PubMed
Summary
This summary is machine-generated.Referring pediatric moyamoya patients to high-volume centers for revascularization improves outcomes and significantly cuts costs for insurers. This approach benefits both patients and insurance companies, even for out-of-network care.
Area Of Science
- Neurosurgery
- Vascular Surgery
- Health Economics
Background
- Moyamoya disease is a rare pediatric arteriopathy causing stroke risk.
- High-volume centers improve surgical revascularization outcomes.
- Private insurers often deny out-of-network care for rare diseases.
Purpose Of The Study
- To test if high-volume centers improve outcomes and reduce costs for pediatric moyamoya revascularization.
- To evaluate a partnership care model for rare disease treatment.
Main Methods
- Analyzed deidentified data of 125 pediatric moyamoya patients (2018-2020).
- Compared clinical and cost outcomes across centers using ICD-10 codes.
- Designated highest-volume center as the primary cohort for analysis.
Main Results
- Primary cohort patients were younger with more comorbidities but had fewer complications and readmissions.
- The primary cohort experienced 42% lower costs ($89K vs. $153K).
- Partnership model reduced out-of-network costs via local preoperative workup (68% vs. 8%).
Conclusions
- Referral to high-volume centers for pediatric moyamoya surgery improves patient outcomes.
- High-volume centers offer substantial cost savings for insurers.
- Centers of excellence benefit patients and insurers, even for out-of-network care.
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