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1.
BMC Neurol ; 20(1): 312, 2020 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-32825828

RESUMEN

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) created a new reimbursement model "Bundled Payment for Care Improvement (BPCI)" which reimburses providers a predetermined payment in advance to cover all possible services rendered within a certain time window. Chordoma and Chondrosarcoma are locally aggressive malignant primary bony tumors. Treatment includes surgical resection and radiotherapy with substantial risk for recurrence which necessitates monitoring and further treatment. We assessed the feasibility of the BPCI model in these neurosurgical diseases. METHODS: We selected patients with chordoma/chondrosarcoma from inpatient admission table using the International Classification of Disease, 9th (ICD-9), and 10th (ICD-10) revision codes. We collected the patients' demographics and insurance type at the index hospitalization. We recorded the following outcomes length of stay, total payment, discharge disposition, and complications for the index hospitalization. For post-discharge, we collected the 30 days and 3/6/12 months inpatient admission, outpatient service, and medication refills. Continuous variables were summarized by means with standard deviations, median with interquartile and full ranges (minimum-maximum); Continuous outcomes were compared by nonparametric Wilcoxson rank-sum test. All tests were 2-sided with a significance level of 0.05. Statistical data analysis was performed in SAS 9.4 (SAS Institute, Inc, Cary, NC). RESULTS: The population size was 2041 patients which included 1412 patients with cranial (group1), 343 patients with a mobile spine (group 2), and 286 patients with sacrococcygeal (group 3) chordoma and chondrosarcoma. For index hospitalization, the median length of stay (days) was 4, 6, and 7 for groups 1, 2, and 3 respectively (P<.001). The mean payments were ($58,130), ($84,854), and ($82,440), for groups 1, 2, and 3 respectively (P=.02). The complication rates were 30%, 35%, and 43% for groups 1, 2, and 3 respectively (P<.001). Twelve months post-discharge, the hospital readmission rates were 44%, 53%, and 65% for groups 1, 2, and 3, respectively (P<.001). The median payments for this period were ($72,294), ($76,827), and ($101,474), for groups 1, 2, and 3, respectively (P <.001). CONCLUSION: The management of craniospinal chordoma and chondrosarcoma is costly and may extend over a prolonged period. The success of BPCI requires a joint effort between insurers and hospitals. Also, it should consider patients' comorbidities, the complexity of the disease. Finally, the adoptionof quality improvement programs by hospitals can help with cost reduction.


Asunto(s)
Condrosarcoma/terapia , Cordoma/terapia , Medicare/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Centers for Medicare and Medicaid Services, U.S. , Condrosarcoma/economía , Cordoma/economía , Estudios de Factibilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Paquetes de Atención al Paciente/economía , Alta del Paciente , Readmisión del Paciente , Mejoramiento de la Calidad/economía , Estados Unidos , Adulto Joven
2.
Ann Surg Oncol ; 22(11): 3466-73, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25564171

RESUMEN

BACKGROUND: The prevalence and cost of unnecessary advanced imaging studies (AIS) in the evaluation of long bone cartilaginous lesions have not been studied previously. METHODS: A total of 105 enchondromas and 19 chondrosarcomas arising in long bones from July 2008 until April 2012 in 121 patients were reviewed. Advanced imaging was defined as MRI, CT, bone scan, skeletal survey, or CT biopsy. Two blinded radiologists independently reviewed the initial imaging study and determined if further imaging was indicated based on that imaging study alone. The cost of imaging was taken from our institution's global charge list. Imaging was deemed unnecessary if it was not recommended by our radiologists after review of the initial imaging study. The difference in cost was calculated by subtracting the cost of imaging recommended by each radiologist from the cost of unnecessary imaging. The sensitivity and specificity for distinguishing enchondromas from chondrosarcomas was calculated. A minimum of 2 years from diagnosis of an enchondroma was required to monitor for malignant transformation. RESULTS: Of patients diagnosed with an enchondroma, 85 % presented with AIS. The average enchondroma patient presented with one unnecessary AIS. The radiologists' interpretations agreed 85 % of the time for enchondromas and 100 % for chondrosarcomas. The sensitivity and specificity for distinguishing enchondromas from chondrosarcomas was 95 % for one radiologist and 87 and 95 % for the other. The average unnecessary cost per enchondroma patient was $1,346.18. CONCLUSIONS: Unnecessary AIS are frequently performed and are a significant source of expense. The imaging algorithms outlined in this study may reduce unnecessary AIS.


Asunto(s)
Neoplasias Óseas/diagnóstico , Condroma/diagnóstico , Condrosarcoma/diagnóstico , Biopsia Guiada por Imagen/estadística & datos numéricos , Imagen por Resonancia Magnética/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Procedimientos Innecesarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/economía , Condroma/economía , Condrosarcoma/economía , Diagnóstico Diferencial , Femenino , Fémur , Peroné , Humanos , Húmero , Biopsia Guiada por Imagen/economía , Imagen por Resonancia Magnética/economía , Masculino , Persona de Mediana Edad , Cintigrafía/economía , Cintigrafía/estadística & datos numéricos , Radio (Anatomía) , Sensibilidad y Especificidad , Tibia , Tomografía Computarizada por Rayos X/economía , Procedimientos Innecesarios/economía , Procedimientos Innecesarios/estadística & datos numéricos , Adulto Joven
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