Article Text

Download PDFPDF
Original research
Drivers of variation in 90-day episode payments after mechanical thrombectomy for acute ischemic stroke
  1. Badih J Daou1,
  2. Monica L Yost1,
  3. John D Syrjamaki1,
  4. Kelsey J Fearer1,
  5. Sravanthi Koduri1,
  6. James F Burke2,
  7. Joseph J Gemmete3,
  8. Neeraj Chaudhary4,
  9. Byron Gregory Thompson1,
  10. Aditya S Pandey1
  1. 1 Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Neurology, University of Michigan Health System, Ann Arbor, Michigan, USA
  3. 3 Radiology and Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
  4. 4 Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Aditya S Pandey, Neurosurgery, University of Michigan, Ann Arbor, MI 48109-5338, USA; adityap{at}med.umich.edu

Abstract

Background 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 to 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.

Results 1076 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), highlighting a significant payment variation across hospital terciles. 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 $7525–$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).

Conclusions 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.

  • stroke
  • thrombectomy
  • economics

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request.

View Full Text

Footnotes

  • Twitter @kelseyjayna

  • Contributors All authors made significant contributions to this work. BJD: Drafting manuscript, revising manuscript, analysis of data and interpretation. MLY: Acquisition of data, statistical analysis, revision of manuscript, administrative and technical support. JDS: Acquisition of data, statistical analysis, revision of manuscript, administrative and technical support. KJF: Data analysis, study supervision, administrative and technical support. SK: Data analysis, revision of manuscript. JFB: Data analysis, statistical analysis, revision of manuscript, administrative and technical support. JJG: Revision of manuscript, administrative and technical support NC: Revision of manuscript, administrative and technical support. BGT: Revision of manuscript, administrative and technical support. ASP: Study supervision, drafting of manuscript, revision of manuscript, conceptualization.

  • 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 MLY and JDS receive salary support from Blue Cross Blue Shield of Michigan for their work with the Michigan Value Collaborative.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.