Drivers of variation in 90-day episode payments after mechanical thrombectomy for acute ischemic stroke.
Publication/Presentation Date
6-1-2021
Abstract
BACKGROUND: Although mechanical thrombectomy for acute ischemic stroke from a large vessel occlusion is now the standard of care, little is known about cost variations in stroke patients following thrombectomy and factors that influence these variations.
METHODS: We evaluated claims data for 2016 to 2018 for thrombectomy-performing hospitals within Michigan through a registry that includes detailed episode payment information for both Medicare and privately insured patients. We aimed to analyze price-standardized and risk-adjusted 90-day episode payments in patients who underwent thrombectomy. Hospitals were grouped into three payment terciles for comparison. Statistical analysis was carried out using unpaired
RESULTS: 1076 thrombectomy cases treated at 16 centers were analyzed. The average 90-day episode payment by hospital ranged from $53 046 to $81,767, with a mean of $65 357. A $20 467 difference (35.1%) existed between the high and low payment hospital terciles (P< 0.0001), highlighting a significant payment variation across hospital terciles. The primary drivers of payment variation were related to post-discharge care which accounted for 38% of the payment variation (P=0.0058, inter-tercile range $11,977-$19,703) and readmissions accounting for 26% (P=0.016, inter-tercile range $3,315-$7,992). This was followed by professional payments representing 20% of the variation (P< 0.0001, inter-tercile range $7525-$9,922), while index hospitalization payment was responsible for only 16% of the 90-day episode payment variation (P=0.10, inter-tercile range $35,432-$41,099).
CONCLUSIONS: There is a wide variation in 90-day episode payments for patients undergoing mechanical thrombectomy across centers. The main drivers of payment variation are related to differences in post-discharge care and readmissions.
Volume
13
Issue
6
First Page
519
Last Page
523
ISSN
1759-8486
Published In/Presented At
Daou, B. J., Yost, M. L., Syrjamaki, J. D., Fearer, K. J., Koduri, S., Burke, J. F., Gemmete, J. J., Chaudhary, N., Thompson, B. G., & Pandey, A. S. (2021). Drivers of variation in 90-day episode payments after mechanical thrombectomy for acute ischemic stroke. Journal of neurointerventional surgery, 13(6), 519–523. https://doi.org/10.1136/neurintsurg-2020-016389
Disciplines
Medicine and Health Sciences
PubMedID
32737204
Department(s)
Department of Surgery
Document Type
Article