Simulating Episode-Based Bundled Payments for Cranial Neurosurgical Procedures
Zachary Medress, MD
Background. Episode-based bundled payments were introduced by Medicare in 2013 as the Bundled Care Improvement Initiative (BPCI) in order to improve care coordination and cost efficiency. BPCI has been implemented for orthopedic, cardiac, and spine procedures, but has not yet been expanded to cranial neurosurgical
Methods. We performed a large retrospective observational study using the MarketScan administrative database to project bundled payment payments for common cranial neurosurgical procedures. Operations were classified into four groups: Craniotomy for unruptured aneurysm, meningioma, malignant glioma, and metastasis. We project 30-, 60-, and 90-day bundle payments for each category, and analyze the contributions of post-discharge payments, medical comorbidities, adjuvant therapies, and discharge status to total bundle payments at each time point.
Results. We identified 15,276 procedures that met our inclusion criteria. We observed significant variability between projected bundle payments despite similar index hospitalization payments between groups. Multivariate analysis showed that medical comorbidities, adjuvant therapies, hospital readmission, and discharge destination significantly affect cranial bundle projections.
Conclusions. For the first time in our knowledge, we report projected costs of 30-, 60-,and 90-day episode-based bundled payments for common elective vascular and tumor cranial operations. Compared to spine and orthopedic procedures, postdischarge costs significantly impact total bundle payments in cranial neurosurgery.