90-Day Bundled Payment Simulation, Health Care Utilization, and Complications Following Craniopharyngioma Resection in Adult Patients

Overview

Journal J Neurol Surg B Skull Base

Publisher Thieme

Date 2022 Sep 13

PMID 36097499

Authors

Nicholas Dietz

Mayur Sharma

Kevin John

Dengzhi Wang

Beatrice Ugiliweneza

Sriprakash Mokshagundam

Martin F Bjurstrom

Maxwell Boakye

Brian J Williams

Norberto Andaluz

Affiliations

Soon will be listed here.

Abstract

Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown. This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection. This study is presented as a retrospective cohort analysis (2000-2016) with 2 years of follow-up. The study included national inpatient hospitalization and outpatient visits. Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC). This study investigated transphenoidal or subfrontal approach for tumor resection. Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study. Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; < 0.0001). ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection.

Citing Articles

Improved healthcare utilization and economic outcomes of chronic subdural hematoma treatment with middle meningeal artery embolization compared to conventional surgical drainage.

John K, Dietz N, Brake A, Ugiliweneza B, Drazin D, Abecassis I Interv Neuroradiol. 2025; 15910199241311628.

PMID: 39819108 PMC: 11748395. DOI: 10.1177/15910199241311628.

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