Association Between Hospital Finances, Payer Mix, and Complications After Hyperthermic Intraperitoneal Chemotherapy: Deficiencies in the Current Healthcare Reimbursement System and Future Implications

• Published in: Annals of surgical oncology 2015-05, Vol.22 (5), p.1739-1745
• Main Authors: Squires, Malcolm H., Staley, Christopher A., Knechtle, William, Winer, Joshua H., Russell, Maria C., Perez, Sebastian, Sweeney, John F., Maithel, Shishir K., Staley, Charles A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy, Adjuvant; Chemotherapy, Cancer, Regional Perfusion; Combined Modality Therapy; Cytoreduction Surgical Procedures - economics; Female; Follow-Up Studies; Healthcare Policy and Outcomes; Hospital Costs; Humans; Hyperthermia, Induced - economics; Length of Stay; Male; Medicare; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Neoplasms - economics; Neoplasms - pathology; Neoplasms - therapy; Oncology; Peritoneal Neoplasms - economics; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Postoperative Complications; Prognosis; Prospective Studies; Retrospective Studies; Surgery; Surgical Oncology; United States
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-4025-7

Background Despite increasing implementation of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), there are little data on its financial implications. We analyzed hospital cost and reimbursement data within the context of insurance provider type and postoperative complications. Methods Clinicopathologic variables, hospital costs, and reimbursement for all patients undergoing CRS/HIPEC at a single institution from 2009 to 2013 were analyzed. Results A total of 64 patients underwent CRS/HIPEC. Median PCI score was 19, and average operative time was 550 min. Tumor histology included appendiceal ( n  = 40; 62 %), colorectal ( n  = 16; 25 %), goblet cell ( n  = 5; 8 %), and mesothelioma ( n  = 3; 5 %). Median length-of-stay was 13 days. Complications occurred in 42 patients (66 %), including 13 (20 %) with major (Clavien grade III–IV) complications. Payer mix included 42 private insurance and 22 Medicare/Medicaid. Financial data was available for 56 patients: average total hospital cost was $49,248 and reimbursement was $63,771, for a hospital profit of $14,523/patient. Despite similar costs between Medicare/Medicaid and private-insurance patients, Medicare/Medicaid reimbursed much less ($30,713 vs $80,747; p