Author + information
- Phillip P. Brown,
- Aaron Kugelmass,
- David Cohen,
- Matthew Reynolds,
- Marc Katz,
- Michael Schlosser,
- April Simon and
- Steven Culler
Background: A proposed episode based payment (bundle) for CABG necessitates understanding resource consumption during the 90 day perioperative period. This study reports the impact of complications on resources utilization by type of services during the 90-day follow-up period.
Methods: This retrospective study examined FY 2014 Medicare Files for hospitals, post-acute care facilities, home health care, and outpatient visits. The study sample is 38,730 Medicare Beneficiaries (MBs) who underwent CABG surgery and were discharged alive. This analysis compares Medicare reimbursement between those MBs that experience at least one complication-including new onset hemodialysis, ARDS, infections, and stroke to those MBs that did not.
Results: A total of 4,306 (11.12%) MBs experienced at least one complication during their CABG admission. MBs experiencing a complication during their CABG hospitalization had 50% greater (p<0.01) index hospitalization and post discharge costs. MBs with an index complication were more likely to die, and consumed greater resources for readmission, post-acute, and ambulatory care during the follow-up period.
Conclusions: Medicare's CABG bundle payment will place hospitals at financial risk. Index complications result in a 50% increase in resource utilization ($19,000 per case). Identifying populations at risk for complications, and mitigating untoward outcomes is critical in proposed CABG payment models.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1166-321
- 2017 American College of Cardiology Foundation