V. C. Sanderfer1, S. Ross1, B. Matthews1, L. Schiffern1, H. Yang2, M. H. Jang3, C. E. Reinke1 1Atrium Health, Carolinas Medical Center, Department Of Surgery, Charlotte, NC, USA 3Wake Forest University School Of Medicine, Winston-Salem, NC, USA 2Atrium Health, Information And Analytics Services, Charlotte, NC, USA
Introduction: The Medicare Bundled Payments for Care Improvement initiative created a model in which a single, prospectively determined bundled payment encompassed all services furnished by the hospital during the 90-day episode of care. The goal was to align incentives with changes in care structure designed to improve quality of care and decrease care utilization after major surgery. Major Bowel Episodes of Care (MB-EoC) have been the focus amongst general surgery procedures. Our aim was to examine MB-EoC within a large health system to determine the contribution of emergency bowel surgery to higher costs of care and the potential impact of more robust screening colonoscopy programs on cost savings.
Methods: Adult colectomy cases from July 2018 to November 2022 who had claims data in the HealtheIntent or HealthePlanet were reviewed for 90-day EoC costs. The excess costs for non-elective care was determined and potential percent cost savings were calculated for the total costs as well as individual components. Patients aged ≥45 years who had non-elective surgery for colon cancer had incidence of prior screening colonoscopy determined based on chart review. Percent cost savings were calculated for emergency colon cancer cases and if they were converted to elective procedure.
Results: 1292 colectomy cases were identified. Mean age was 65 years. 90% of patients had Medicare/commercial insurance and 41% had a primary diagnosis of colon cancer. 28% of cases were non-elective, and these cases had a higher proportion of Medicaid/underinsured patients (21% vs 7%, p<0.001) and higher utilization of post-discharge cost-drivers: home health, hospice, discharge to facility and readmissions. 90-day EoC cost per case was 66% higher for non-elective colon cases, primarily driven by higher costs during the index visit and readmissions. 43% (40/93) of eligible colon cancer patients had ever undergone a colonoscopy, however 68% (63/93) had not undergone a colonoscopy in the 5 years prior to their index visit and 54% (34/63) of these had no documented discussion of the need for a colonoscopy. If 100% of emergent colon cancer patients had undergone screening colonoscopy and been converted to elective procedures, their 90-day MB-EOC costs would decrease by 28%.
Conclusions: Emergency MB-EoC cases disproportionally contribute to higher 90-day care utilization and costs. Efforts to increase screening colonoscopy in appropriate populations may have a substantial impact on MB-EoC costs.
