John Syrjamaki

Identifying Drivers of Episode Cost Variation With Radical Prostatectomy

OBJECTIVE To describe total and component radical prostatectomy (RP) episode costs across a diverse set of hospitals in Michigan, and examine drivers of variation in such payments. METHODS We identified Medicare and private payer patients undergoing RP from 2012 to 2014 from the claims-based registry maintained by the Michigan Value Collaborative, a statewide consortium that provides hospitals with price-standardized and risk-adjusted 90-day episode costs for common medical and surgical procedures. We divided hospitals into quartiles based on mean total episode cost for RP. Total episode costs were further classified into 4 payment categories: index hospitalization, professional services, readmissions, and postacute care. Component payments were then compared across high-cost and low-cost hospitals. RESULTS We identified 3077 patients undergoing RP in 42 hospitals. Mean 90-day total episode cost was

Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey

14,614, ranging from

Drivers of Payment Variation in 90-Day Coronary Artery Bypass Grafting Episodes

13,043 to

MAGNITUDE AND DETERMINANTS OF VARIATION IN PERCUTANEOUS CORONARY INTERVENTION PAYMENTS

16,749 across quartiles (28.4% difference, P < .001). Overall variation in total episode cost was divided nearly equally among readmissions (29%), postacute care (29%), and professional payments (26%). We noted significantly higher readmission (

HOSPITAL LEVEL VARIATIONS IN EPISODE COSTS FOR ATRIAL FIBRILLATION

1442 vs

PD14-04 ROUTINE HOME HEALTH AFTER PROSTATECTOMY DOES NOT REDUCE ED VISITS OR CATHETER COMPLICATIONS

288, P = .03) and postacute care payments at high-cost hospitals (

THE HIGH COST OF CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTIONS

1686 vs

ARE HIGHER HOSPITAL APPROPRIATENESS SCORES FOR PERCUTANEOUS CORONARY INTERVENTION LINKED TO FEWER 30-DAY READMISSIONS?

522, P = .002). CONCLUSION Significant variation exists in 90-day total episode costs for RP, suggesting a potential target for bundled payments and other care improvement efforts. Focused efforts on reducing variation in readmissions and postacute care could improve cost-efficiency.

CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTIONS IS ASSOCIATED WITH MORE 30-DAY HOSPITAL READMISSIONS

In 2012, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to capture key elements of patient satisfaction, including pain management. HCAHPS surveys are administered to patients 48 hours to 6 weeks after discharge, and scores are used to determine hospital payments.1 However, patients complete surveys during a time when many are filling postdischarge opioid prescriptions. This timing has raised concerns that HCAHPS measures could inadvertently incentivize clinicians to overprescribe opioids after discharge to ensure satisfactory ratings and reimbursement.2,3 Citing these concerns, CMS announced it will remove pain management from its determination of hospital payments beginning in 2018, even though little is known regarding the potential correlation between HCAHPS scores and postdischarge opioid prescribing.3 We sought to evaluate the association between HCAHPS pain measures and postoperative opioid prescribing in surgical patients, which accounts for nearly 40% of surgical prescriptions.

Transcatheter vs. Surgical Aortic Valve Replacement Episode Payments and Relationship to Case Volume

Importance Coronary artery bypass grafting (CABG) is scheduled to become a mandatory Medicare bundled payment program in January 2018. A contemporary understanding of 90-day CABG episode payments and their drivers is necessary to inform health policy, hospital strategy, and clinical quality improvement activities. Furthermore, insight into current CABG payments and their variation is important for understanding the potential effects of bundled payment models in cardiac care. Objective To examine CABG payment variation and its drivers. Design, Setting, and Participants This retrospective cohort study used Medicare and private payer claims to identify patients who underwent nonemergent CABG surgery from January 1, 2012, through October 31, 2015. Ninety-day price-standardized, risk-adjusted, total episode payments were calculated for each patient, and hospitals were divided into quartiles based on the mean total episode payments of their patients. Payments were then subdivided into 4 components (index hospitalization, professional, postacute care, and readmission payments) and compared across hospital quartiles. Seventy-six hospitals in Michigan representing a diverse set of geographies and practice environments were included. Main Outcomes and Measures Ninety-day CABG episode payments. Results A total of 5910 patients undergoing nonemergent CABG surgery were identified at 33 of the 76 hospitals; of these, 4344 (73.5%) were men and mean (SD) age was 68.0 (9.3) years. At the patient level, risk-adjusted, 90-day total episode payments for CABG varied from