Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
J Vasc Surg. 2021 Mar;73(3):1062-1066. doi: 10.1016/j.jvs.2020.06.117. Epub 2020 Jul 21.
The fiscal impact of endovascular repair (EVR) of aortic aneurysms and the requisite device costs have previously highlighted the tenuous long-term financial sustainability among Medicare beneficiaries. The Centers for Medicare & Medicaid Services have since reclassified EVR remuneration paradigms with new Medicare Severity Diagnosis-Related Groups (MS-DRGs) intended to better address the procedure's cost profile. The impact of this change remains unknown. The purpose of this analysis was to compare EVR-specific costs and revenue among Medicare beneficiaries both before and after this change.
All infrarenal EVRs performed in fiscal years (FYs) 2014 and 2015, before the MS-DRG change, and those performed in FYs 2017 and 2018, after the MS-DRG change, were identified using the DRG codes 238 (n = 108) and 269 (n = 84), respectively. We then identified those who were treated according to the instructions for use guidelines with a single manufacturer's device and billed to Medicare (n = 23 in FY14-15; n = 22 in FY17-18). From these cohorts, we determined total procedure technical costs, technical revenue, and net technical margin in conjunction with the hospital finance department. Results were then compared between these two groups.
The two cohorts demonstrated similar demographic profiles (FY14-15 vs FY17-18 cohort: age, 78 years vs 74 years; median length of stay, 1.0 day vs 1.0 day). Mean total technical costs were slightly higher in the FY17-18 group ($24,511 in FY14-15 vs $26,445 in FY17-18). Graft implants continued to account for a significant portion of the total cost, with the device cost accounting for 56% of the total procedure costs in both cohorts. Net revenue was greater in the FY17-18 group by $5800 ($30,698 in FY14-15 vs $36,498 in FY17-18), resulting in an increased overall margin in the FY17-18 group compared with the FY14-15 group ($6188 in FY14-15 vs $10,053 in FY17-18).
Device costs remain the single greatest cost driver associated with EVR delivery. DRG reclassification of EVR to address total procedure and implant costs appears to better address the requisite associated procedure costs and may thereby better support long-term fiscal sustainability of this procedure for hospitals and health systems alike.
血管内修复（EVR）治疗主动脉瘤的财政影响和必要的设备成本此前突显了医疗保险受益人的长期财务可持续性存在问题。为此，医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）对 EVR 报酬模式进行了重新分类，引入了新的医疗保险严重程度诊断相关组（Medicare Severity Diagnosis-Related Groups，MS-DRGs），旨在更好地解决该手术的成本情况。但这一变化的影响仍不得而知。本分析的目的是比较 Medicare 受益人的 EVR 特定成本和收入，分别在这一变化之前（2014 财年和 2015 财年，使用 DRG 代码 238）和之后（2017 财年和 2018 财年，使用 DRG 代码 269）。使用 DRG 代码 238（n=108）和 269（n=84）分别识别了这两个时期的所有肾下 EVR 手术。然后，我们从这些队列中确定了那些根据使用说明手册，使用单一制造商设备进行治疗并向 Medicare 收费的患者（2014-15 年有 23 例；2017-18 年有 22 例）。从这些队列中，我们与医院财务部一起确定了总手术技术成本、技术收入和净技术利润率。然后对这两组数据进行比较。
这两个队列的人口统计学特征相似（2014-15 年与 2017-18 年队列：年龄，78 岁与 74 岁；中位住院时间，1.0 天与 1.0 天）。2017-18 年组的总技术成本略高（2014-15 年为 24511 美元，2017-18 年为 26445 美元）。移植物植入物仍然占总成本的很大一部分，在两个队列中，设备成本占总手术成本的 56%。2017-18 年组的净收入增加了 5800 美元（2014-15 年为 30698 美元，2017-18 年为 36498 美元），与 2014-15 年相比，2017-18 年组的总利润率增加了 6188 美元（2014-15 年为 6188 美元，2017-18 年为 10053 美元）。
设备成本仍然是与 EVR 治疗相关的最大成本驱动因素。为解决总手术和植入物成本而对 EVR 进行的 DRG 重新分类似乎更好地解决了必要的相关手术成本，从而可能更好地支持医院和医疗系统长期的财务可持续性。
