Preoperative acute care spending predicts costs in bundled payment programs

Area of Science:

• Health economics
• Healthcare policy
• Surgical outcomes

Background:

• Alternative Payment Models (APMs), like Bundled Payments for Care Improvement (BPCI), aim to reduce surgical episode costs through lump-sum payments.
• Current APMs have not consistently achieved net savings, indicating a need for improved cost-containment strategies.
• Preoperative care significantly influences postoperative expenditures, suggesting its inclusion in cost-saving initiatives.

Purpose of the Study:

• To evaluate the association between preoperative and postoperative acute care costs for four BPCI-targeted surgical procedures.
• To identify clinical and nonclinical drivers of perioperative costs within these surgical episodes.

Main Methods:

• Retrospective cohort study using 2018 Healthcare Cost and Utilization Project data from four US states.
• Included patients with preoperative and postoperative acute care encounters within 90 days of surgery.
• Multivariable ordered logistic regression models analyzed cost associations across pre-, intra-, and postoperative quartiles.

Main Results:

• Episode-related costs varied widely, from $12,808 to $70,286.
• Patients in the highest preoperative cost quartile had a significantly higher likelihood (13.7 percentage points) of remaining in the highest postoperative cost quartile.
• Facility-level BPCI participation was associated with increased preoperative costs.

Conclusions:

• Preoperative spending is a robust predictor of subsequent postoperative expenditures.
• Incorporating the preoperative-postoperative cost relationship can enhance APM design and performance.
• Further research may refine strategies for cost reduction in surgical care episodes.