Impact of Complications on Resource Utilization during 90-day CABG Bundle for Medicare Beneficiaries
The study reports the impact of adverse events during the index CABG surgery on Medicare reimbursement for the index hospitalization and a 90-day follow-up period.
This retrospective study used 2014 Medicare claims files for hospitals, skilled nursing services, rehabilitation facilities, long-term care facilities, home health services and outpatient visits. The study sample is 37,106 Medicare beneficiaries that survived an index CABG in a US hospital during the first three quarters of 2014. Adverse events included acute renal failure; new onset hemodialysis; post-operative respiratory failure; any infection (post-operative infection, or sepsis); post-operative shock and hemorrhage; post-operative stroke, and reoperation during index hospitalization.
Total average Medicare reimbursement for all services consumed during index CABG hospitalization and the 90-day post-discharge period was $42,063±$23,284. The index CABG hospitalization accounted for $32,544±$14,406, 77.4% of the bundle. MBs experiencing at least one adverse event had significantly higher total average Medicare reimbursement by $15,941 ($54,280 versus $38,339) for the bundle compared to MBs not experiencing an adverse event. The risk-adjusted incremental Medicare reimbursement for the entire 90-day bundle exceeded $20,000 for four adverse events (new-onset hemodialysis - $33,250, septicemia - $32,063, post-operative stroke - $24,117, and post-operative infection - $23,801).
Medicare beneficiaries that experience adverse events during their index CABG hospitalization will significantly impact that hospital's financial risk. The challenge under the voluntary CABG bundled payment program will be to monitor and reduce adverse events and managing the services consumed by Medicare beneficiaries experiencing adverse events delivered at all the venues of care.
Culler SD, Brown PP, Kugelmass AD, Cohen DJ, Reynolds MR, Katz MR, Schlosser ML, Simon AW. Impact of Complications on Resource Utilization during 90-day CABG Bundle for Medicare Beneficiaries. Ann Thorac Surg. 2018 Dec 13.