90-Day Bundled Payment Simulation, Healthcare Utilization, and Complications following Craniopharyngioma Resection in Adult Patients

Background: Bundle payment models and healthcare utilization metrics have gained increased interest to optimize costs and patient outcomes in health systems for surgical procedures, and intracranial interventions may be incorporated into bundled payments for care improvement. There is yet no study of bundle payments and healthcare utilization for craniopharyngioma resection, known to have a challenging and higher complication profile.

Objective: To identify the impact of different endocrine and non-endocrine complications on healthcare utilization and bundled payments following craniopharyngioma resection.

Materials and Methods: We used International Classification of Diseases (ICD) 9/10 and Current Procedural Terminology (CPT) codes to extract data from MarketScan (2000–2016). Patients who underwent craniopharyngioma resection were divided into the following groups: group 1: no complications (NC), group 2: only endocrine complications (EC), group 3: non-endocrine complications (NEC), and group 4: both endocrine and nonendocrine complications (ENEC). Outcomes of interest were hospital readmission rates, and healthcare utilization at index hospitalization, 6, 12, and 24 months following discharge.

Results: Of 2,059 patients identified from the MarketScan database, 78% of patients were in group NC, 13% in group EC, 5% in group NEC, and 4% in group ENEC. Only 12% of patients had transfrontal approach (TFA) for surgical resection and 88% had transsphenoidal approach (TSA). Overall, median age was 51 years and 53% of patients were females. Commercial insurance was used in 78% of patients and the majority of patients (61%) had Elixhauser comorbidity score of 0 and 1. Patients in group NC had shorter median length of hospital stay (3 days) compared to 4 days in rest of the groups. Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared to those in EC ($32,847), NEC ($36,259), and ENEC ($32,596). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; ENEC: 111,841), p < 0.0001. Also, 90-day median bundled payment was significantly different among the cohorts with highest in ENEC ($60,728) and lowest in the NC ($33,089), p < 0.0001.

Conclusion: The majority of patients underwent transsphenoidal surgery for craniopharyngioma without complications (78%) in the study population. Patients with combined endocrine and non-endocrine complications following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year, and 2 years compared to those without complications. Type of complications and readmission rates should be considered to optimize prediction of payment models following surgery for craniopharyngioma. These findings may provide framework for policymakers and physicians regarding re-imbursement for this challenging pathology.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021