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 PVSS19. Addressing the Disconnect Between Reimbursement and Patient Value in Aortic Surgery

​​Mandy R. Maness1, Matthew B. Burruss1, Marcus Gillikin2, Timothy W. Capps1, Jill N. Zink1, Charles S. Powell1, William M. Bogey1, Frank M. Parker1, Michael C. Stoner1
1East Carolina University, Department of Cardiovascular Sciences, Section of Vascular and Endovascular Surgery, Greenville, NC; 2East Carolina Heart Institute, Greenville, NC.

OBJECTIVES: Patient-centric value is defined as health outcome achieved per dollar spent; however, current reimbursement is predicated on volume of service, not value achieved. The purpose of this study is to examine the relationship between hospital value and patient value using contemporary and hypothetical payment schemas for aortic surgery.

METHODS: Ten-year clinical and inflation-corrected financial data were collected for patients undergoing abdominal aortic aneurysm repair (AAA). Comorbid profile was quantified using a modified Charlson Comorbidity Index (CCI). Patient value (freedom from complication (d) / total charges ($)) was compared to a novel measure of hospital value (contribution margin($) / bed-day (d)) via regression analyses.
RESULTS: Five hundred nine patients had complete clinical and financial data to be included in the analysis. The average reimbursement was $21k and comparison of patient value (range 0 to 19 d/$10k) to hospital value (range -36k to +31k $/d) yields a weak correlation (r2=0.027, Figure). Reimbursement schema were hypothesized utilizing base payment ($5k - $20k), value multiplier and CCI risk adjustment keeping total expenditure static. With decreasing base payment ($20k, $15k, $10k, $5k) correlation between hospital value and patient value improved (r2=0.116, 0.202, 0.273 and 0.322; $10k base payment results shown in Figure 1).
CONCLUSIONS: Contemporary aortic surgery payment fails to reward health care systems for patient value. A risk-adjusted value-based payment reconciles this issue and rewards health care systems for high value patient care.
AUTHOR DISCLOSURES: W. M. Bogey: Nothing to disclose; M. B. Burruss: Nothing to disclose; T. W. Capps: Nothing to disclose; M. Gillikin: Nothing to disclose; M. R. Maness: Nothing to disclose; F. M. Parker: Nothing to disclose; C. S. Powell: Nothing to disclose; M. C. Stoner: Nothing to disclose; J. N. Zink: Nothing to disclose.
Regression Analysis for Current (blue) and Value-Based (green) Aortic Surgery Reimbursement
Posted April 2013

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