Jordan M. Cloyd

Hospital Teaching Status and Medicare Expenditures for Hepato-Pancreato-Biliary Surgery

BackgroundThe association of hospital teaching status and overall expenditures has not been studied among patients undergoing hepato-pancreato-biliary (HPB) surgery. We sought to define the impact of hospital teaching intensity on payments and charges associated with (HPB) surgery from the payer perspective.MethodsSurgical patients undergoing HPB procedures were identified using 2013–2015 Medicare Provider Analysis and Review (MEDPAR) data. Hospital teaching intensity was categorized based on hospital resident-to-bed ratio: non-teaching (NTH: 0), minor teaching (minor-TH: 0–0.363), and major teaching (major-TH: u2009>u20090.363). Risk-adjusted price-standardized Medicare payments were assessed and compared among HPB surgical patients at NTH versus major-TH.ResultsA total of 8863 patients underwent HPB (NTH: nu2009=u20091239, 14.0%; minor-TH: nu2009=u20093202, 36.1%; major-TH: nu2009=u20094422, 49.9%). Patient comorbidities did not vary across hospital according to teaching intensity (pu2009=u20090.27). Mean risk-adjusted Medicare payment at a major-TH was

Clinical significance and prognostic relevance of KRAS, BRAF, PI3K and TP53 genetic mutation analysis for resectable and unresectable colorectal liver metastases: A systematic review of the current evidence

29,541 versus

Impact of Post-Discharge Disposition on Risk and Causes of Readmission Following Liver and Pancreas Surgery

19,345 at a NTH (Δ-payment:u2009+u2009

Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Has Nodal Evaluation Been Increasingly Adopted by Surgeons over Time?A National Database Analysis

10,195; pu2009<u20090.001). Differences in Medicare payments associated with hospital teaching status persisted when the risk-adjusted price was standardized to remove social subsidies and regional variation in costs (NTH:

Emerging treatment options for cholangiocarcinoma

19,760 vs. major-TH:

Surgical approaches for the treatment of perihilar cholangiocarcinoma

28,382; Δ-payment: u2009+u2009

Predictors of Readmission After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

8623). Major-TH had higher total charges submitted to Medicare versus NTH (NTH:

Time to Readmission and Mortality Among Patients Undergoing Liver and Pancreatic Surgery

100,583 vs. major-TH:

Role of associating liver partition and portal vein ligation in staged hepatectomy (ALPPS)—strategy for colorectal liver metastases

120,498; Δ-chargeu2009=u2009+u2009

Influence of English proficiency on patient-provider communication and shared decision-making

19,915), including charges for accommodations, laboratory, and blood utilization (all pu2009<u20090.05). Compared with NTH, major-TH had lower morbidity (22.6 vs. 19.0%), serious complications (13.0 vs. 10.5%) and 30-day mortality (4.8 vs. 2.3%) (all pu2009<u20090.05).ConclusionsMajor-TH was associated with higher Medicare expenditures than NTH among HPB surgical patients. These differences were attributable, in part, to higher submitted charges for hospital-based services. While associated with higher payments and charges, TH did have better short-term outcomes compared with NTH.