Drivers of Variation in 90-Day Episode Payments After Mechanical Thrombectomy for Acute Ischemic Stroke

• Published in: Neurosurgery Vol. 67; no. Supplement_1
• Main Authors: Daou, Badih J, Yost, Monica, Syrjamaki, John, Burke, James F, Gemmete, Joseph, Chaudhary, Neeraj, Thompson, Byron G, Pandey, Aditya S
• Format: Journal Article
• Language: English
• Published: Philadelphia Wolters Kluwer Health, Inc 01-12-2020
• Subjects: Ischemia; Neurosurgery; Stroke; Surgical techniques
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa447_354

INTRODUCTION Although mechanical thrombectomy for acute ischemic stroke from a large vessel occlusion is now the standard of care, little is known about cost variations in stroke patients following thrombectomy and factors that influence these variations. METHODS We evaluated claims data for 2016–2018 for thrombectomy-performing hospitals within Michigan through a registry that includes detailed episode payment information for both Medicare and privately insured patients. We aimed to analyze price-standardized and risk-adjusted 90-day episode payments in patients who underwent thrombectomy. Hospitals were grouped into three payment terciles for comparison. Statistical analysis was carried out using unpaired t-test, Chi-square and ANOVA tests as appropriate. RESULTS 1,076 thrombectomy cases treated at 16 centers were analyzed. The average 90-day episode payment by hospital ranged from $53,046 to $81,767, with a mean of $65,357. A $20,467 difference (35.1%) existed between the high and low payment hospital terciles (P < 0.0001). The primary drivers of payment variation were related to post-discharge care which accounted for 38% of the payment variation (P = .0058, inter-tercile range $11,977-$19,703) and readmissions accounting for 26% (P = .016, inter-tercile range $3,315-$7,992). This was followed by professional payments representing 20% of the variation (P < .0001, inter-tercile range $7,525 to $9,922), while index hospitalization payment was responsible for only 16% of the 90-day episode payment variation (P = .10, inter-tercile range $35,432-$41,099). High payment hospitals were more likely to discharge to a skilled nursing facility (difference of 14.9%, P < .0001). CONCLUSION There is a wide variation in 90-day episode payments for patients undergoing mechanical thrombectomy across centers. The main drivers of payment variation are related to differences in post-discharge care and readmissions across centers.