The Correlation Between Patient Comorbidities and Bundled Payment Expenditures

Abstract

Abstract TITLE: The Correlation Between Patient Comorbidities and Bundled Payment Expenditures Jordan Anderson, Anamika Chaudhuri, Timothy Ferris, Sree Chaguturu Purpose: Episode-based payments have been developed as an alternative payment methodology to reduce unnecessary healthcare spending and improve outcomes for acute episodes of care. In this study we examine eleven different acute episodes of care to determine the correlation between a patient’s comorbidity burden and their total medical expenditures for a longitudinal 90-day episode-of-care. Methods: Using historical claims data, patients admitted for one of the defined episodes of care were assigned a clinical risk score using the Elixhauser Van-Walraven Comorbidity Index (EVCI). Total medical expenses were summed over a longitudinal 90-day episode of care using the Medicare grouping methodology. A correlation analysis was used to assess the association between patient EVCI score and longitudinal 90-day medical expenditures. Results: The correlation between EVCI and episode expenditures ranged from the highest correlation for major bowel surgery (R=0.22; p < 0.0001) to the lowest correlation value for double joint replacement lower extremity (R= -0.05 ; p = 0.62). The results also showed variability in the range of EVCI scores for different conditions. Congestive heart failure (EVCI: 23.19; SD 12.25) had the highest average EVCI score indicating a high-degree of comorbidity amongst patients. Whereas cervical spinal fusion surgery (EVCI: 7.38; SD 11.12) had the lowest average EVCI score. Conclusions: The correlation between patient EVCI score and longitudinal 90-day expenditures varied across different acute episodes of care, but were found to demonstrate an overall weak correlation.