Drivers of variation in 90-day episode payments after mechanical thrombectomy for acute ischemic stroke. (31st July 2020)

• Record Type: Journal Article
• Authors: Daou, Badih J; Yost, Monica L; Syrjamaki, John D; Fearer, Kelsey J; Koduri, Sravanthi; Burke, James F; Gemmete, Joseph J; Chaudhary, Neeraj; Thompson, Byron Gregory; Pandey, Aditya S
• Is Part Of: Journal of neurointerventional surgery. Volume 13:Number 6(2021)
• Page Start: 519
• Page End: 523
• Publication Date: 2020-07-31
• Subjects: stroke -- thrombectomy -- economics; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2020-016389
• Languages: English
• ISSNs: 1759-8478

Abstract

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 t -test, Chi-square, and ANOVA tests. 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.