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Case series
Capitated pricing model for stroke thrombectomies: a single center experience across three companies
  1. Kavit Shah1,
  2. Merritt Brown2,
  3. Shashvat M Desai3,
  4. Tudor G Jovin4,
  5. Ashutosh P Jadhav5,
  6. Bradley A Gross6,
  7. Brian Thomas Jankowitz7
  1. 1 Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  2. 2 Neurology and Neurosurgery, Louisiana State University in New Orleans, New Orleans, Louisiana, USA
  3. 3 Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4 Neurology, Cooper Hospital University Medical Center, Camden, New Jersey, USA
  5. 5 Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6 Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  7. 7 Neurosurgery, Cooper Hospital University Medical Center, Camden, New Jersey, USA
  1. Correspondence to Dr Brian Thomas Jankowitz; jankbt{at}upmc.edu

Abstract

Background With a continued rise in healthcare expenditures, there is a demonstrable focus on curbing expenses. Mechanical thrombectomy (MT) is the standard of treatment for large vessel occlusions (LVOs); however, considerable costs are associated with devices utilized in each procedure. We report our institution’s experience with capitation pricing models negotiated with three different companies.

Methods We retrospectively reviewed a prospectively maintained database from February 2018 to August 2019 identifying cases performed under capitation models. We calculated the cost of equipment for each thrombectomy using the cost for individual devices utilized (virtual) and compared this sum to the total derived from cost-negotiated bundled equipment packages. This was compared with real-world cases that did not meet capitation criteria during this study period.

Results 107 cases met the criteria for capitation; 39 cases used company A’s models (28 with stentrievers), 44 cases used company B’s models (3 with stentrievers), and 24 cases used company C’s models (14 with stentrievers). Overall, there was a net savings of $202 370.50 utilizing the capitated model ($689 435 vs $891 805.50), amounting to $1891.31 savings per case. Mean capitation was lower ($6972±2774) compared with virtual ($8794±4614) and real-world non-capitation costs ($7176±3672).

Conclusion The negotiated capitated pricing model yielded total cost savings associated with equipment from each company. Overall mean capitation costs were lower than virtual and real-world cases. This may serve as a model for other centers in controlling costs for patients undergoing MT for LVO.

  • stroke
  • thrombectomy
  • catheter
  • stent

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Footnotes

  • Twitter @kshah917, @shashvatdesaiMD, @ashupjadhav

  • Contributors Drafting the article: KS. Acquisition of data/data analysis: KS, MB, SMD. Reviewed and revised article prior to submission: all authors. Study supervision: BAG, BTJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TGJ: Consultant: Stryker Neurovascular (PI DAWN – unpaid), Ownership Interest: Anaconda, Advisory Board/Investor; FreeOx Biotech, Advisory Board/Investor; Route92, Advisory Board/Investor; Blockade Medical, Consultant; Honoraria: Cerenovus. BAG: Consultant: Microvention, Medtronic. BTJ: Consultant: Medtronic.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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