Development of a Charge Adjustment Model for Cardiac Catheterization

Abstract

A methodology that would allow for comparison of charges across institutions has not been developed for catheterization in congenital heart disease. A single institution catheterization database with prospectively collected case characteristics was linked to hospital charges related and limited to an episode of care in the catheterization laboratory for fiscal years 2008–2010. Catheterization charge categories (CCC) were developed to group types of catheterization procedures using a combination of empiric data and expert consensus. A multivariable model with outcome charges was created using CCC and additional patient and procedural characteristics. In 3 fiscal years, 3,839 cases were available for analysis. Forty catheterization procedure types were categorized into 7 CCC yielding a grouper variable with an R2 explanatory value of 72.6 %. In the final CCC, the largest proportion of cases was in CCC 2 (34 %), which included diagnostic cases without intervention. Biopsy cases were isolated in CCC 1 (12 %), and percutaneous pulmonary valve placement alone made up CCC 7 (2 %). The final model included CCC, number of interventions, and cardiac diagnosis (R2 = 74.2 %). Additionally, current financial metrics such as APR-DRG severity of illness and case mix index demonstrated a lack of correlation with CCC. We have developed a catheterization procedure type financial grouper that accounts for the diverse case population encountered in catheterization for congenital heart disease. CCC and our multivariable model could be used to understand financial characteristics of a population at a single point in time, longitudinally, and to compare populations.

Determinants of Resource Utilization in a Tertiary Pediatric and Congenital Echocardiographic Laboratory

“…Similar method has been used to predict high resource utilization patients in pediatric emergency departments 7 and in pediatric and congenital cardiac catheterization. 8 The parameters associated with high resource utilization identified here are plausible from workflow and clinical perspectives. For example, the firsttime studies are expected to take longer than follow-up examinations as they require comprehensive anatomic and hemodynamic evaluations.…”

Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation

“…The unit costs were kept fixed throughout the analysis to control for the impact of inflation and contractual insurance adjustments. Due to variable cost of inpatient admissions, catheterizations, and cardiac surgeries, more accurate patient specific costs were calculated based on global charge bundles as previously reported . These global charge bundles provide more accurate charges based on procedure complexity.…”

“…Due to variable cost of inpatient admissions, catheterizations, and cardiac surgeries, more accurate patient specific costs were calculated based on global charge bundles as previously reported. 7,8 These global charge bundles provide more accurate charges based on procedure complexity. Overhead costs were not included in charge calculations, as these were not expected to change due to the implementation of SCAMPS.…”