Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model

Abstract

Background: The Centers for Medicare and Medicaid Services (CMS) created a new reimbursement model "Bundled Payment for Care Improvement (BPCI)" which reimburses providers a predetermined payment in advance to cover all possible services rendered within a certain time window. Chordoma and Chondrosarcoma are locally aggressive malignant primary bony tumors. Treatment includes surgical resection and radiotherapy with substantial risk for recurrence which necessitates monitoring and further treatment. We assessed the feasibility of the BPCI model in these neurosurgical diseases. Methods: We selected patients with chordoma/chondrosarcoma from inpatient admission table using the International Classification of Disease, 9th (ICD-9), and 10th (ICD-10) revision codes. We collected the patients' demographics and insurance type at the index hospitalization. We recorded the following outcomes length of stay, total payment, discharge disposition, and complications for the index hospitalization. For post-discharge, we collected the 30 days and 3/6/12 months inpatient admission, outpatient service, and medication refills. Continuous variables were summarized by means with standard deviations, median with interquartile and full ranges (minimum-maximum); Continuous outcomes were compared by nonparametric Wilcoxson rank-sum test. All tests were 2-sided with a significance level of 0.05. Statistical data analysis was performed in SAS 9.4 (SAS Institute, Inc, Cary, NC). Results: The population size was 2041 patients which included 1412 patients with cranial (group1), 343 patients with a mobile spine (group 2), and 286 patients with sacrococcygeal (group 3) chordoma and chondrosarcoma. For index hospitalization, the median length of stay (days) was 4, 6, and 7 for groups 1, 2, and 3 respectively (P<.

Single-Surgeon Versus Dual-Surgeon Strategy in Spinal Tumor Surgery

“…W ith an aging population and improvements in oncological care, there is a concurrent increase in spinal oncology operations. [1][2][3][4] Numerous studies in the spine surgery literature have focused on complication prediction and reduction, with an increased focus on those areas with the highest complication rates, namely spinal oncology and spinal deformity. [5][6][7][8][9][10] There is growing evidence supporting a dual attending surgeon approach for spinal deformity operations, [11][12][13][14][15][16][17][18][19][20][21][22] with putative benefits of decreased estimated blood loss (EBL), decreased operative time, and reduced complications.…”

“…With an aging population and improvements in oncological care, there is a concurrent increase in spinal oncology operations 1–4. Numerous studies in the spine surgery literature have focused on complication prediction and reduction, with an increased focus on those areas with the highest complication rates, namely spinal oncology and spinal deformity 5–10.…”