F. Gani1, M. Cerullo1, J. K. Canner1, A. E. Harzman2, S. G. Husain2, W. C. Cirocco2, M. W. Arnold2, A. Traugott2, T. M. Pawlik1,2 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 2Ohio State University,Department Of Surgery,Columbus, OH, USA
Introduction: Colorectal cancer (CRC) represents the second leading cause of cancer, as well as the second most expensive cancer in the United States. While the implementation of a bundled care payment model has been proposed to curtail the increasing financial burden associated with the treatment of CRC, the distribution and determinants of payments among privately insured patients remain largely unknown. The current study sought to characterize and explain differences in payments received for the treatment of CRC using a cohort of commercially insured patients.
Methods: Patients >18 years of age, who underwent a colorectal surgery with a primary diagnosis of colon or rectal cancer were identified using the Truven Health MarketScan Database for 2010-2014. Total payments associated with surgery, chemotherapy and / or radiation therapy were calculated. Nonparametric, multivariable linear regression analysis was used to calculate and compare risk-adjusted payments between patients.
Results: A total of 32,782 patients were identified who underwent a colorectal resection for cancer. The median age of the study population was 55 years (IQR: 49-60) with 54.4% (n=17,823) being male. Comorbidities were common as 49.1% (n=16,142) patients presented with preexisting comorbidity (Charlson comorbidity index (CCI)>2). The median risk-adjusted payment for surgery was $27,726 (IQR: $20,099-$40,013), ranging from $17,528 among patients in the lowest quartile of payments to $40,968 among patients included in the highest quartile of payments (+Δ $23,440, p<0.001). Greater preoperative comorbidity (CCI=2 vs. CCI>6: $36,082 vs. $40,944) and the development of a postoperative complication (no complication vs. complication: $35,823 vs. $44,858) were associated with higher payments (both p<0.001). Following surgery, 44.0% of patients received adjuvant therapy. Marked variations in payments received for adjuvant therapy were observed ranging from $366 / cycle of chemotherapy for patients in the lowest quartile of payments to $10,426 / cycle of chemotherapy among patients included in the highest quartile of payments (+Δ $10,060, p<0.001). Among patients included within the lowest quartile of payments chemotherapy accounted for 13.7% of all payments received; in contrast, among patients included in the highest quartile, chemotherapy related payments accounted for 63.4% of all payments received (+Δ 49.7%). Payments received for radiation therapy were comparable among all patients and accounted for <1% of all payments.
Conclusion: Payments associated with the care of CRC varied significantly despite case-mix and geographical adjustment. Variations in payments were largely due to differences in chemotherapy, and less due to differences in payments for surgery. Episode-based bundle payments for surgery and chemotherapy may differentially impact reimbursement for CRC associated care.