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Abstract
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.
Methods We evaluated claims data 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 at Michigan hospitals. 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=0.0058, inter-tercile range $11,977-$19,703) and readmissions accounting for 26% (P=0.016, inter-tercile range $3,315-$7,992). This was followed by professional payments representing 20% of the variation (P<0.0001, 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=0.10, 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<0.0001).
Conclusion There is a wide variation in 90-day episode payments for patients undergoing thrombectomy across centers within a single state.
Disclosures B. Daou: None. M. Yost: None. J. Syrjamaki: None. K. Fearer: None. S. Koduri: None. J. Burke: None. J. Gemmete: None. N. Chaudhary: None. B. Thompson: None. A. Pandey: None.