Highlights
- •30-day episode spending was $2654 higher among beneficiaries living in neighborhoods with high levels of deprivation compared to those in the least deprived.
- •Higher Medicare spending was in part driven by higher rates of readmissions (12.9% vs. 10.8%) and post-acute care (67.8% vs. 61.2%) among beneficiaries living in the most deprived neighborhoods.
- •The was a significant difference in payments between dual-eligible beneficiaries in the most and least deprived neighborhoods for the index hospitalization ($21,287 vs. $19,927).
Abstract
Introduction
The Center of Medicare and Medicaid Services valued based payments for inpatient surgical
hospitalizations are adjusted for clinical but not social risk factors. While research
has shown that social risk is associated with worse surgical patient outcomes, it
is unknown if inpatient surgical episode Medicare payments are affected by social
risk factors.
Methods
Retrospective review of Medicare beneficiaries, age 65–99, undergoing appendectomy,
colectomy, hernia repair, or cholecystectomy between 2014 and 2018. Neighborhood deprivation
measured by Area Deprivation Index for beneficiary census tract. We evaluated Medicare
payments for a total episode of surgical care comprised of index hospitalization,
physician fees, post-acute care, and readmission by beneficiary neighborhood deprivation.
Results
A total of 809,059 patients (Women, 56.0%) and mean (SD) age of 75.7 (7.4 years were
included. A total of 145,351 beneficiaries lived in the least deprived neighborhoods
and 134,188 who lived in the most deprived neighborhoods. Total surgical episode spending
was $2654 higher among beneficiaries from the most deprived neighborhoods compared
to those from the least after risk adjustment for clinical and hospital factors. These
differences were driven in part by higher rates of readmissions (12.9% vs 10.8%, P < 0.001)
and post-acute care (67.8% vs. 61.2%, P < 0.001) among beneficiaries living in the
most deprived neighborhoods.
Conclusion
These findings suggest that value-based payment models with inclusion of social risk
adjustment may be needed for surgical cohorts. Moreover, efforts focused on investing
in deprived communities may be aligned with surgical quality improvement.
Keywords
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Article info
Publication history
Published online: June 11, 2022
Accepted:
June 2,
2022
Received in revised form:
June 1,
2022
Received:
April 25,
2022
Identification
Copyright
Published by Elsevier Inc.
