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Bundled payments, also known as episode of care payments, have received increased attention from payers as a mechanism to control healthcare costs and promote quality. Hospitals are increasingly in need of metrics to understand resource utilization beyond the index hospitalization, extending out 30, 60 and 90 days post-discharge. The purpose of this analysis was to identify “episode of care” costs for Transcatheter Aortic Valve Replacement (TAVR) patients including the index hospitalization and all post-discharge care through 30, 60 and 90 day time periods.
We retrospectively evaluated 6,352 patients receiving TAVR in 2013 from Medicare claims. Using Medicare Cost Reports, we calculated the total episode of care costs for the index TAVR hospitalization and defined periods of post-discharge care including 30, 60 and 90 days. Episodic costs included the index admission, physician fees, subsequent inpatient admissions (readmissions), skilled nursing facility (SNF), hospital outpatient and home health (HH). Inpatient rehabilitation and long term care were excluded as cost information were not available for these services. Rates of post-discharge care use and length of stay were calculated where available.
The average index hospitalization cost for TAVR in 2013 was $65,701 as shown in Table 1. The average episode of care costs were $74,629, $78,438 and $80,860 at 30, 60 and 90 days, respectively. Readmissions were the largest driver of post-discharge resource utilization followed by physician costs, SNF, HH and hospital outpatient. Readmission rates were 18.9%, 27.8%, and 35.3% at 30, 60, and 90 days, respectively. Among TAVR patients with readmissions, the average length of stay for the readmissions were 5.8, 5.7 and 5.7 days for the three time points, respectively.
Episode of care costs beyond the index hospitalization are increasingly important as payers and providers explore new bundled payment approaches. After the index hospitalization, readmissions were the biggest driver of resource utilization in Medicare patients receiving TAVR. Careful consideration of strategies to reduce the risk of readmissions after TAVR may be warranted to reduce resource use and improve quality. These findings may be a helpful benchmark for providers seeking information on the episode of care costs.
|30 Days*||60 Days*||90 Days*|
|Skilled Nursing Facility||$1,453||$1,741||$1,857|