Retained Blood Syndrome in Cardiac Surgeries is associated with higher costs over a 90-day Episode of Care at Three Top Hospitals
In Cardiovascular
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By: Neha Thomas Jun. 29, 2020
Retained blood syndrome (RBS) occurs when drainage systems fail to adequately evacuate blood during recovery from cardiothoracic surgery. Dexur analyzed RBS related complications at three top hospitals to understand value outcomes over a 90-day episode of care. Hospitals, ACOs & Payors benefit from value outcomes and cost of care outcomes data to help manage overall population health. Patients benefit from this data as they can make informed choices regarding the facilities that will provide them the best care for specific conditions with the best value. Value outcomes are also closely aligned to bundled payment initiatives by CMS and other payors.
Methodology to understand the impact of RBS on cost outcomes over a 90-day episode of care is given below:
- Medicare claims data from Apr 2016 to Mar 2019 were used for this analysis
- Cardiac Surgeries were identified based on Cardiothoracic & Coronary Bypass DRGs (DRG 216-220 & DRG 231-236)
- In all Cardiac Surgeries, RBS was identified based on ICD 10 codes such as Pleural Effusions and other RBS related complications
- The hospitals that were included in the study were: Cleveland Clinic (Cleveland, OH), Mayo Clinic (Rochester, MN) and Morristown Medical Center (Morristown, NJ)
- Cost (defined as payments by Medicare) outcomes were tracked from the initial date of admission to 90 days
- The cost outcomes that were included are given below
| Cost of Care Components | Description | Hospice Avg. LOS (Oct 2016 to Sep 2019) | Avg. Payment for Hospice User (Oct 2016 to Sep 2019) |
|---|---|---|---|
| Index Hospitalization | Admission Cost plus Discharge Cost at the initial hospital | 51.68 | $11,380 |
| First interaction nursing home cost | Cost incurred at the first nursing home visited post-discharge from the hospital where index hospitalization happened | 17.36 | $5,318 |
| Other interaction nursing home cost | Cost incurred at other nursing homes post-discharge from the first interaction nursing home | 14.44 | $4,772 |
| First interaction home health agency cost | Cost incurred at the first home health agency visited post-discharge from the hospital where index hospitalization happened | 21.58 | $6,444 |
| Other interaction home health agency cost | Cost incurred at other home health agencies post-discharge from the first interaction HHA | 11.63 | $4,697 |
| Rehospitalization costs | Cost incurred due to re-hospitalization post initial discharge | 21.39 | $5,966 |
| ED cost | Cost incurred for care at any Emergency Department post-discharge from the hospital where index hospitalization happened |
Results:
The results (in the below table) show that the RBS cohort was associated with higher costs for all the three hospitals analyzed - $7946 (Cleveland Clinic), $11,328 (Mayo Clinic), and $9,578 (Morristown Medical Center)
| Hospital | Avg. Cost of Care over a 90 Day Episode of Care with RBS | Avg. Cost of Care over a 90 Day Episode of Care without RBS | Difference |
|---|---|---|---|
| Cleveland Clinic (Cleveland, OH) | $57,151 | $49,205 | $7,946 |
| Mayo Clinic (Rochester, MN) | $77,840 | $66,512 | $11,328 |
| Morristown Medical Center (Morristown, NJ) | $62,861 | $53,283 | $9,578 |
