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Episode-based Payment Variation for Urologic Cancer Surgery.

Publication ,  Journal Article
Ellimoottil, C; Li, J; Ye, Z; Dupree, JM; Min, HS; Kaye, D; Herrel, LA; Miller, DC
Published in: Urology
January 2018

OBJECTIVE: To investigate payment variation for 3 common urologic cancer surgeries and evaluate the potential for applying bundled payment programs to these procedures. METHODS: Using 2008-2011 Surveillance, Epidemiology, and End Results-Medicare linked data, we identified all beneficiaries aged greater than 65 years who underwent cystectomy, prostatectomy, or nephrectomy for cancer. Total episode payments were determined by aggregating hospital, professional, and post-acute care claims from the index surgical hospitalization through 90 days post discharge. Total episode payments were then compared to examine hospital level-variation within each procedure type and the specific payment components (ie, index hospitalization, professional, readmission, and post-acute care) driving spending variation. RESULTS: Ninety-day episodes of care were identified for 1849 cystectomies, 8770 prostatectomies, and 4304 nephrectomies. We observed wide variation in mean episode payments for all 3 conditions (cystectomy mean $35,102: range $24,112-$57,238, prostatectomy mean $10,803: range $8,816-$17,877, nephrectomy mean $17,475: range $11,681-$26,711). Majority of payment variation was attributable to index hospitalization and post-acute care for cystectomy and nephrectomy and professional payments for prostatectomy. The most expensive hospitals by procedure each demonstrated a unique opportunity for spending reduction due to individual differences in component payment patterns between hospitals. CONCLUSION: Ninety-day episode payments for urologic cancer surgery vary widely across hospitals in the United States. The key drivers of this payment variation differ for individual procedures and hospitals. Accordingly, hospitals will need individualized data and clinical re-design strategies to succeed with implementation of episode-based payment models for urologic cancer care.

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Published In

Urology

DOI

EISSN

1527-9995

Publication Date

January 2018

Volume

111

Start / End Page

78 / 85

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urologic Neoplasms
  • Reimbursement Mechanisms
  • Prostatectomy
  • Nephrectomy
  • Humans
  • Episode of Care
  • Cystectomy
  • Aged, 80 and over
  • Aged
 

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Ellimoottil, C., Li, J., Ye, Z., Dupree, J. M., Min, H. S., Kaye, D., … Miller, D. C. (2018). Episode-based Payment Variation for Urologic Cancer Surgery. Urology, 111, 78–85. https://doi.org/10.1016/j.urology.2017.08.053
Ellimoottil, Chad, Jonathan Li, Zaojun Ye, James M. Dupree, Hye Sung Min, Deborah Kaye, Lindsey A. Herrel, and David C. Miller. “Episode-based Payment Variation for Urologic Cancer Surgery.Urology 111 (January 2018): 78–85. https://doi.org/10.1016/j.urology.2017.08.053.
Ellimoottil C, Li J, Ye Z, Dupree JM, Min HS, Kaye D, et al. Episode-based Payment Variation for Urologic Cancer Surgery. Urology. 2018 Jan;111:78–85.
Ellimoottil, Chad, et al. “Episode-based Payment Variation for Urologic Cancer Surgery.Urology, vol. 111, Jan. 2018, pp. 78–85. Pubmed, doi:10.1016/j.urology.2017.08.053.
Ellimoottil C, Li J, Ye Z, Dupree JM, Min HS, Kaye D, Herrel LA, Miller DC. Episode-based Payment Variation for Urologic Cancer Surgery. Urology. 2018 Jan;111:78–85.
Journal cover image

Published In

Urology

DOI

EISSN

1527-9995

Publication Date

January 2018

Volume

111

Start / End Page

78 / 85

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urologic Neoplasms
  • Reimbursement Mechanisms
  • Prostatectomy
  • Nephrectomy
  • Humans
  • Episode of Care
  • Cystectomy
  • Aged, 80 and over
  • Aged