title: Identifying Drivers of Episode Cost Variation With Radical Prostatectomy.
abstract: To describe total and component radical prostatectomy (RP) episode costs across a diverse set of hospitals in Michigan, and examine drivers of variation in such payments.
  
  
  
  We identified Medicare and private payer patients undergoing RP from 2012 to 2014 from the claims-based registry maintained by the Michigan Value Collaborative, a statewide consortium that provides hospitals with price-standardized and risk-adjusted 90-day episode costs for common medical and surgical procedures. We divided hospitals into quartiles based on mean total episode cost for RP. Total episode costs were further classified into 4 payment categories: index hospitalization, professional services, readmissions, and postacute care. Component payments were then compared across high-cost and low-cost hospitals.
  
  
  
  We identified 3077 patients undergoing RP in 42 hospitals. Mean 90-day total episode cost was $14,614, ranging from $13,043 to $16,749 across quartiles (28.4% difference, P < .001). Overall variation in total episode cost was divided nearly equally among readmissions (29%), postacute care (29%), and professional payments (26%). We noted significantly higher readmission ($1442 vs $288, P = .03) and postacute care payments at high-cost hospitals ($1686 vs $522, P = .002).
  
  
  
  Significant variation exists in 90-day total episode costs for RP, suggesting a potential target for bundled payments and other care improvement efforts. Focused efforts on reducing variation in readmissions and postacute care could improve cost-efficiency.
authors: Dow Division of Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI.
authors: Lindsey A
authors: LA
authors: Herrel
authors: Dow Division of Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI.
authors: John D
authors: JD
authors: Syrjamaki
authors: Dow Division of Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors: Susan M
authors: SM
authors: Linsell
authors: Dow Division of Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI.
authors: David C
authors: DC
authors: Miller
authors: Dow Division of Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI. Electronic address: jmdupree@med.umich.edu.
authors: James M
authors: JM
authors: Dupree
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D006278:Medicare / Q000191:economics; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D011468:Prostatectomy / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000379:methods; D014481:United States