Abstract

Background

The Centers for Medicare & Medicaid Services (CMS) recently announced a new voluntary episode payment model for major bowel surgery. The purpose of this study was to examine the financial impact of bundled payments for major bowel surgery.

Methods

An institutional database was retrospectively queried for all patients who underwent major bowel surgery between July 2016 and June 2018. Procedures were categorized using MS-DRG coding: MS-DRG 329 (with MCC, major complications and comorbidity), MS-DRG 330 (with CC, complications and comorbidity), and MS-DRG 331 (without CC/MCC).

Results

A total of 745 patients underwent 798 procedures, with mean age 62.1 years and BMI 29.2 kg/m². The median LOS was 4.0 days, with 12.5% of patients being discharged to a post-acute care facility for an average of 38.5 days. The mean hospital cost was $18,525. The mean payment to a post-acute care facility was $423 per day. The 90-day readmission rate was 8.6% at an average cost of $12,859 per readmission. Patients with major complications and comorbidity (MS-DRG 329) had higher CMS Hierarchical Condition Categories scores, longer LOS, higher costs, more required home health services or post-acute care facilities, and had higher 90-day readmissions. In a fee-for-service model, hospital reimbursements resulted in a negative margin of − 8.2% for MS-DRG 329, − 2.6% for MS-DRG 330, but a positive margin of 2.8% for MS-DRG 331. In a bundled payment model, the hospital would incur a loss of − 13.1%, − 11.1%, and − 1.9% for MS-DRG 329, 330, and 331, respectively.

Conclusions

Patients undergoing major bowel surgery are often a heterogeneous population with varied pre-existing comorbid conditions who require a high level of complex care and utilize greater hospital resources. Further study is needed to identify areas of cost containment without compromising the overall quality of care.

中文翻译：

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我们准备好大肠手术的捆绑付款吗？

摘要

背景

医疗保险和医疗补助服务中心（CMS）最近宣布了一项针对大肠手术的新的自愿分期付款模式。这项研究的目的是检查捆绑支付对大肠手术的财务影响。

方法

回顾性地查询了2016年7月至2018年6月间所有进行大肠手术的患者的机构数据库。采用MS-DRG编码对程序进行了分类：MS-DRG 329（具有MCC，主要并发症和合并症），MS-DRG 330（具有CC，并发症和合并症）和MS-DRG 331（无CC / MCC）。

结果

总共745例患者接受了798例手术，平均年龄为62.1岁，BMI为29.2 kg / m ^2。。中位LOS为4.0天，平均12.5％的患者出院后平均护理时间为38.5天。平均住院费用为18,525美元。支付给急性后护理机构的平均费用为每天423美元。90天的重新入学率为8.6％，平均每次重新入学费用为$ 12,859。具有重大并发症和合并症（MS-DRG 329）的患者具有更高的CMS分层疾病分类评分，更长的LOS，更高的费用，更多的家庭保健服务或急诊后护理设施，以及90天的再入院率更高。在按服务付费模型中，医院报销导致MS-DRG 329的负边际为-8.2％，MS-DRG 330的负边际为-2.6％，而MS-DRG 331的正边际为2.8％。如果采用捆绑付款模式，则医院将因MS-DRG 329，330损失− 13.1％，− 11.1％和− 1.9％，

结论

进行大肠手术的患者通常是异质性人群，具有多种既存的合并症，需要高水平的复杂护理并利用更多的医院资源。需要进一步的研究来确定成本控制领域，而又不损害整体护理质量。