Presentation Authors: Meera Chappidi*, San Francisco, CA, CJ Stimson, Nashville, TN, Max Kates, Baltimore, MD, Anobel Odisho, San Francisco, CA, Trinity Bivalacqua, Baltimore, MD
Introduction: Episode based, or &[Prime]bundled,&[Prime] payment models hold a single entity accountable for all spending in the 90-day post-op period. Given its volume and financial impact, radical prostatectomy (RP) is likely to be a focus of future policy expansions. However, non-index hospital readmissions (NIHRs) would be outside the financially responsible provider&[prime]s control. We compared causes and costs of index and non-index hospital readmissions (IHRs vs. NIHRs) following RP.
Methods: We identified prostate cancer patients undergoing RP from 2010-2014 in the Nationwide Readmissions Database. Sociodemographic factors, hospital costs, and causes of 90d readmissions were compared between all IHRs vs. NIHRs. Multivariable regression models were used to determine if NIHRs were more expensive then IHRs for several causes of readmission.
Results: Among the 214,473 RP patients, the 90d readmission rate was 5.7% (n=12,316) with 11.7% (n=1,438) of those experiencing multiple readmissions. There were 13,998 90d readmissions with 30.6% (n=4283) at NIHRs. NIHRs were more likely for CV (16.6 vs 10.3%, p < 0.001) and non-RP specific (49.4 vs. 32.8%, p < 0.001) complications while IHRs were more likely for wound, GU, GI, and bleeding complications (11.2 vs 5.5%; 7.9 vs. 3.9%; 16.5 vs. 6.7%; 8.2 vs 4.3% respectively; all p < 0.001). In multivariable models, readmission costs were significantly higher for NIHRs vs. IHRs ($10,751 vs. $10,113, p=0.008). This difference was even larger for patients (n=9,715) with one only 90d readmission ($10,534 vs. $9,571, p=0.001). CV ($12,995 vs. $10,108, p < 0.001) and electrolyte related ($4,962 vs. $3,179, p=0.01) readmissions were more expensive at NIHRs. For other causes of readmission, representing >80% of readmissions, costs were comparable between NIHRs and IHRs.
Conclusions: In this nationally representative study of readmissions following RP, NIHRs were associated with higher readmission costs, driven by a difference in a subset of readmission causes. For the majority of readmission causes, the cost was comparable between NIHRs and IHRs, indicating there may be little need for additional cost incentives during NIHRs when creating episode based payment models for RP.