Episode-based payment for ischemic stroke care with implications for neurologists

Dobbs, Michael

doi:10.1212/cpj.0000000000000029

Cited by 7 publications

(5 citation statements)

References 8 publications

(9 reference statements)

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“…9 The findings give a bird's eye view of commercial claims data pertinent to neurologists by examining ETGs, the most common classification of disease-related services for commercial payers, and a likely candidate for use in Medicare and Medicaid in the near future. 10 The major study findings are costs of care when a neurologist is involved, the effect of neurologist care on acute and postacute health care utilization, and the effects on disease-specific therapies and screening.…”

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confidence: 99%

Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset

et al. 2016

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Objective: To determine the value of neurologist ambulatory care in chronic neurologic diseases in a large administrative claims dataset detailing costs, adverse events, and health care utilization. Methods:The Optum proprietary claims dataset (2010)(2011)(2012) was examined to describe direct health care costs, as well as specific outcome metrics for a large population of persons with chronic neurologic illnesses. In phase I of the study, we detail neurologist involvement and differences in annualized allowed third-party payments within episode treatment groups (ETGs) for 10 neurologic illnesses. For phase II, we examined health care utilization for ETGs of epilepsy, Parkinson disease (PD), stroke, and multiple sclerosis (MS) with and without neurologist involvement. Reported outcomes were unadjusted differences and odds ratios between treatment groups.Results: For phase I, a total of 1,913,605 ETGs for 10 neurologic conditions were identified, 30.1% meeting criteria for neurologist involvement. All conditions had higher direct costs when neurologists were involved with care, ranging from a 25% increase for Alzheimer dementia to 100% more for MS care. In phase II, fractures, infections, emergent care, and inpatient admission were less with neurologist ambulatory care, while neurologist care was associated with greater utilization of disease-specific treatments (immunotherapies in MS anticoagulation in atrial fibrillation-associated stroke, deep brain stimulation and dopaminergic therapies in PD). Conclusion:Neurologist involvement with care is associated with greater unadjusted allowed payments, but fewer adverse events and less acute care utilization. The effect of neurologist care on health care costs and utilization outcomes in persons with chronic neurologic illness is not well-characterized. Aggregation of health care information in large administrative claims datasets presents an opportunity to assess the effect of specialist physicians on downstream usage of health resources related to the diseases they treat. Payers, from the US Government to third-party private insurers and employers, are looking to this kind of big data analysis to inform coverage, decisions, regulatory actions, and policymaking decisions. 1-5Exploration of large datasets requires access to specialized expertise, programmers, and computing unavailable to clinicians in daily practice. Physician professional organizations, on behalf of their members, have the resources to engage in analysis of these data and advocate for value and quality.6 Therefore, the American Academy of Neurology (AAN) engaged Optum, Inc. (Philadelphia, PA), a health care consulting firm, for a guided exploratory analysis of their proprietary administrative claims dataset to assess the value of neurologist care.

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confidence: 99%

Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset

et al. 2016

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“…Dobbs found inpatient rehabilitation to be the greatest cost encountered during the treatment of a patient with ischemic stroke. 7 As mentioned, mechanical thrombectomy has significantly decreased the degree of disability, thereby decreasing the time spent in inpatient rehabilitation, albeit at a cost. Although the costs associated with inpatient rehabilitation are complex and less tangible, those associated with mechanical thrombectomy represent an avenue to introduce additional savings into the treatment of acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“Strokenomics”: bending the cost curve in stroke care

Munich

Vakharia

McPheeters

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe mortality rates for stroke are decreasing, yet it remains a leading cause of disability and the principal neurological diagnosis in patients discharged to nursing homes. The societal and economic burdens of stroke are substantial, with the total annual health care costs of stroke expected to reach $240.7 billion by 2030. Mechanical thrombectomy has been shown to improve functional outcomes compared to medical therapy alone. Despite an incremental cost of $10,840 compared to medical therapy, the improvement in functional outcomes and decreased disability have contributed to the cost-effectiveness of the procedure. In this study the authors describe a physician-led device bundle purchase program implemented for the delivery of stroke care.METHODSThe authors retrospectively reviewed the clinical and radiographic data and device-associated charges of 45 consecutive patients in whom a virtual “stroke bundle” model was used to purchase mechanical thrombectomy devices.RESULTSUse of the stroke bundle to purchase mechanical thrombectomy devices resulted in an average savings per case of $2900.93. Compared to the traditional model of charging for devices à la carte, this represented an average savings of 25.2% per case. The total amount of savings for these initial 45 cases was $130,542.00. Thrombolysis in Cerebral Infarction scale grade 2b or 3 recanalization occurred in 38 patients (84.4%) using these devices.CONCLUSIONSPurchasing devices through a bundled model resulted in substantial cost savings while maintaining the therapeutic efficacy of the procedure, further pushing the already beneficial long-term cost-benefit curve in favor of thrombectomy.

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“…There have been changes to the systematic approach and funding mechanism of healthcare in Singapore over the past years, with the introduction of Value-based stroke care followed by bundled payments. Bundled payment is also known as episode-based payment, 13 and this can be more complex than the historical fee-for-service reimbursement system (known as diagnostic-related group -DRG). 14 With bundled payment, the funding body makes one lump-sum payment for a package of services provided by multiple providers for a de ned episode of care, 15 including inpatient, community hospital, outpatient, and community services.…”

Section: Discussionmentioning

confidence: 99%

An Integrated Subacute Stroke Ward within a Community Hospital Increases Rehabilitation Efficiency and Reduces Healthcare Expenditure

Tay,

Goh,

Tun

et al. 2023

Preprint

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Background Stroke is a leading cause of hospitalisation, disability, and death in Singapore. The healthcare system’s rehabilitative care model has seen ongoing evolution in response to changing patient needs and healthcare financing demands. Changi General Hospital (CGH) and St. Andrew’s Community Hospital (SACH) collaborated on an integrated subacute stroke ward (SSW) in 2019 to optimise the transfer of stroke patients to the subacute rehabilitation setting. Objective To evaluate the outcomes of the integrated SSW. Methods This was a retrospective study. Anonymised data was used to evaluate functional, financial, and length-of-stay (LOS) outcomes. Results There were 71 patients in the control group (historical cohort) and 226 patients in the SSW cohort. Both groups were demographically, medically, and functionally similar except for a higher proportion of lacunar infarcts (LACI) in the SSW group. Although functional scores by Modified Barthel Index (MBI) were similar on discharge, there was a total LOS fell significantly (20 days) for the SSW group, with significant improvements in median rehabilitation efficiency (19.6 vs 10.9) but not median rehabilitation effectiveness (31.0 vs 34.8). Subgroup analysis revealed no impact from the disproportionate number of LACIs. Gross bill size, when corrected for inflation, was significantly lower across the combined hospitalisation ($31,270 vs $40,005). Conclusions This collaboration achieved savings in healthcare expenditure and LOS without compromising functional outcomes. The community hospital is a potent bridge for care transition and integrated services such as the SSW can optimise the rehabilitation journey for patients with stroke. Innovation in care provision can help to address the ever-changing challenges of healthcare.

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Episode-based payment for ischemic stroke care with implications for neurologists

Cited by 7 publications

References 8 publications

Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset

Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset

“Strokenomics”: bending the cost curve in stroke care

An Integrated Subacute Stroke Ward within a Community Hospital Increases Rehabilitation Efficiency and Reduces Healthcare Expenditure

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