Massachusetts Chapter of the American College of Surgeons

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Cost Analysis of Cleft Care in the First Year of Life: Implications for Development and Feasibility of Bundled Payments for Multidisciplinary Treatment of Cleft Lip/Palate
Ingrid M. Ganske, MD, MPA, Jason W. Yu, MD, DMD, Eric Wenzinger, MD, Karl Sanchez, BA, Olivia Langa, BA, Alex Cappitelli, BA, Tyler T. Nguyen, BS, John Meara, MD, DMD, MBA
Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA

Background: With increased attention to value-based healthcare reform and potential bundled care payments, it is critical to understand the individual components of cost in multidisciplinary models such as cleft care. Understanding the drivers of costs can help focus efforts to design bundled care payments.
Methods: A retrospective review of cost of care was performed for infants that were treated for cleft lip and/or palate (CL/P) at our institution from 2012-2019. Patients with cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP) were included and divided into “isolated” and “complex” cohorts based on the presence of any other co-morbidities.
Results: 199 isolated and 57 complex CL/P patients completed primary cleft repairs within the first year of life. The complex CL/P patients cohort were found to have a higher cost of cleft care relative to isolated in CL ($31,721.55 vs. $22,551.88) and CP ($20,293.94 vs. $19,461.11), but lower for CLP ($58,796.91 vs. $61,234.34). Additionally, all complex CL/P phenotypes had a significantly higher average total cost in a one-year period due to the inherent need for non-cleft care.
Conclusions: The average cost of care for isolated CL/P can be estimated for a defined one-year period. The cost for complex CL/P patients are more difficult to project due to variable completion and co-mingling of costs between cleft and non-cleft care. Given the public and private interest in novel payment models, ongoing cost-tallying exercises are critical in considering patient and cost inclusionary criteria in an effective cleft care bundle.


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