Abstract 4146750: Bundle Payment Reimbursements and Atrial Fibrillation Ablation Outcomes: Analysis of Real-World Data

Background: Bundled payments represent a shift in reimbursement models, promoting value-based care by providing providers a predetermined payment per episode of care rather than fee-for-service. This model incentivizes optimizing patient care while reducing spending on unnecessary tests, treatments, and days hospitalized. Atrial fibrillation (AF) ablation procedures transitioned to bundled payment reimbursements starting January 1, 2022. Research Question: What impact has value-based care made on patient care treatments and outcomes? Methods: This retrospective study utilized the TriNetX Global Research Network to review and compare patient outcomes for AF ablation patients (CPT code 93656) the year leading up to (Jan 1 – Dec 30, 2021) and year subsequent (Jan 1 – Dec 30, 2022) initiation of bundle payments. Propensity score matching was applied to balance cohorts based on demographic characteristics and comorbidities. One-year post-ablation complication rates were analyzed. Results: Propensity score matching of the pre-bundle (N = 14,690) and post-bundle cohorts (N = 16,734) resulted in 14,687 patients from 91 U.S. healthcare organizations. The post-bundle cohort suffered a lower prevalence of circulatory system diseases (ICD-10 code I00-I99) compared to the pre-bundle cohort (91.2% vs 92.4%, p<0.001). The post-bundle cohort was less likely to undergo ablations for subsequent tachyarrhythmias (1.9% vs 2.5%, p=0.006) and lower stroke rates one-year post-ablation (3.3% vs 3.8%, p=0.013). Conclusion: The transition to bundle payment reimbursements for AF ablation procedures was associated with a significant reduction in post-ablation stroke rates and a reduced likelihood of undergoing additional ablations for tachyarrhythmias. Future studies should focus on financial analyses of the AF ablation bundles to further optimize care under this reimbursement model.