Payment variation in CABG episodes of care can affect bundled payments

Editor's Note

Wide variation was found in 90-day coronary artery bypass grafting (CABG) episode payments for Medicare and private payer patients in this study. The differences were driven by increased use of evaluation and management services, higher utilization of inpatient rehabilitation, and patients with multiple readmissions.

In the analysis of 5,910 patients, the highest CABG payment quartile hospitals, compared to the lowest quartile, had significantly higher index hospitalization payments (15%), professional payments (34%), postacute care payments (30%), and readmission payments (35%).

Hospitals and clinicians entering bundled payment programs need to understand the sources of payment variation, the authors say.

Question What are the drivers of payment variation in 90-day coronary artery bypass grafting episodes of care? Findings In this cohort study of 5910 patients, the highest coronary artery bypass grafting payment quartile hospitals, when compared with the lowest payment quartile hospitals, had significantly higher index hospitalization payments (15%), professional payments (34%), postacute care payments (30%), and readmission payments (35%).