The Correlation Between Patient Comorbidities and Bundled Payment Expenditures
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CitationAnderson, Jordan. 2018. The Correlation Between Patient Comorbidities and Bundled Payment Expenditures. Doctoral dissertation, Harvard Medical School.
TITLE: The Correlation Between Patient Comorbidities and Bundled Payment
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
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
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:41973473