Mark A. Healy

Hospital and Payer Costs Associated With Surgical Complications

IMPORTANCE Increased costs of surgical complications have been borne mostly by third-party payers. However, numerous policy changes aimed at incentivizing high-quality care shift more of this burden to hospitals. The potential effect of these policies on hospitals and payers is poorly understood. OBJECTIVE To evaluate costs associated with surgical quality and the relative financial burden on hospitals and payers. DESIGN, SETTING, AND PARTICIPANTS We performed an observational study merging complication data from the Michigan Surgical Quality Collaborative and internal cost accounting data from the University of Michigan Health System from January 2, 2008, through April 16, 2015; the merged files from these data were created between June 5, 2015, and July 22, 2015. A total of 5120 episodes of surgical care for 24 surgical procedure groups (17 general surgical, 6 vascular, and 1 gynecologic) were examined. We report unadjusted and log-transformed risk-adjusted costs. MAIN OUTCOMES AND MEASURES We compared hospital costs, third-party reimbursement (ie, payer costs), and hospital profit margin for cases with and without complications. RESULTS The mean (SD) age of the 5120 patients was 56.0 (16.4) years, and 2883 (56.3) were female. The overall complication rate was 14.5% (744 of 5120) for all procedures, 14.7% (580 of 3956) for general surgery, 15.5% (128 of 828) for vascular surgery, and 10.7% (36 of 336) for gynecologic surgery. For all studied procedures, mean hospital costs were

Long-term Outcomes of Laparoscopic Versus Open Surgery for Clinical Stage I Gastric Cancer: The LOC-1 Study.

19 626 (119%) higher for patients with complications (

Variation in Medicare Expenditures for Treating Perioperative Complications: The Cost of Rescue

36 060) compared with those without complications (

Use of Positron Emission Tomography to Detect Recurrence and Associations With Survival in Patients With Lung and Esophageal Cancers

16 434). Mean third-party reimbursement was

Surgeon Variation in Complications With Minimally Invasive and Open Colectomy: Results From the Michigan Surgical Quality Collaborative

18 497 (106%) higher for patients with complications (

Surgical Treatment Options for Stage IV Melanoma

35 870) compared with those without complications (

Milestones for the Final Mile: Interspecialty Distinctions in Primary Palliative Care Skills Training

17 373). Consequently, with risk adjustment, overall profit margin decreased from 5.8% for patients without complications to 0.1% for patients with complications. CONCLUSIONS AND RELEVANCE Hospitals and third-party payers experience increased costs with surgical complications, with hospitals experiencing a reduction in profit margin. Both hospitals and payers appear to currently have financial incentives to promote surgical quality improvement.

Insurance Status and Hospital Payer Mix Are Linked With Variation in Metastatic Site Resection in Patients With Advanced Colorectal Cancers.

Background: Clinical trials comparing laparoscopic gastrectomy (LG) versus traditional open gastrectomy (OG) have been planned, their surgical outcomes reported but their oncologic outcomes are still pending. Consequently, we have conducted this large-scale historical cohort study to provide relevant information rapidly to guide our current practice. Methods: Through a consensus meeting involving surgeons, biostatisticians, and epidemiologists, 30 variables of preoperative information possibly influencing surgeons’ choice between LG versus OG and potentially associating with outcomes were identified to enable rigorous estimation of propensity scores. A total of 4235 consecutive patients who underwent gastrectomy for gastric adenocarcinoma were identified and their relevant data were gathered from the participating hospitals. After propensity score matching, 1848 patients (924 each for LG and OG) were selected for comparison of long-term outcomes. Results: In the propensity-matched population, the 5-year overall survival was 96.3% [95% confidence interval (CI) 95.0–97.6] in the OG as compared with 97.1% (95% CI, 95.9–98.3) in LG. The number of all-cause death was 33/924 in the OG and 24/924 in the LG through the entire period, and the hazard ratio (LG/OG) for overall death was 0.75 (95% CI, 0.44–1.27; P = 0.290). The 3-year recurrence-free survival was 97.4% (95% CI, 96.4–98.5) in the OG and 97.7% (95% CI, 96.5–98.8) in the LG. The number of recurrence was 22/924 in the OG and 21/924 in the LG through the entire period, and the hazard ratio was 1.01 (95% CI, 0.55–1.84; P = 0.981). Conclusions: This observational study adjusted for all-known confounding factors seems to provide strong enough evidence to suggest that LG is oncologically comparable to OG for gastric cancer.

The association of venous thromboembolism chemoprophylaxis timing on venous thromboembolism after major vascular surgery

Importance Treating surgical complications presents a major challenge for hospitals striving to deliver high-quality care while reducing costs. Costs associated with rescuing patients from perioperative complications are poorly characterized. Objective To evaluate differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery. Design, Setting, and Participants Retrospective cohort study using claims data from the Medicare Provider Analysis and Review files. We compared payments for patients who died vs patients who survived after perioperative complications occurred. Hospitals were stratified using average payments for patients who survived following complications, and payment components were analyzed across hospitals. Administrative claims database of surgical patients was analyzed at hospitals treating Medicare patients nationwide. This study included Medicare patients aged 65 to 100 years who underwent abdominal aortic aneurysm repair (n = 69 207), colectomy for cancer (n = 107 647), pulmonary resection (n = 91 758), and total hip replacement (n = 307 399) between 2009 and 2012. Data analysis took place between November 2015 and March 2016. Exposures Clinical outcome of surgery (eg, no complication, complication and death, or complication and survival) and the individual hospital where a patient received an operation. Main Outcomes and Measures Risk-adjusted, price-standardized Medicare payments for an episode of surgery. Risk-adjusted perioperative outcomes were also assessed. Results The mean age for Medicare beneficiaries in this study ranged from 74.1 years (pulmonary resection) to 78.2 years (colectomy). The proportion of male patients ranged from 37% (total hip replacement) to 77% (abdominal aortic aneurysm repair), and most patients were white. Among patients who experienced complications, those who were rescued had higher price-standardized Medicare payments than did those who died for all 4 operations. Assessing variation across hospitals, payments for patients who were rescued at the highest cost-of-rescue hospitals were 2- to 3-fold higher than at the lowest cost-of-rescue hospitals for abdominal aortic aneurysm repair (

Multimodal cancer care in poor prognosis cancers: Resection drives long-term outcomes.

60 456 vs