Variation in value among hospitals performing complex cancer operations.

Published on Jul 1, 2020in Surgery3.982
· DOI :10.1016/J.SURG.2020.03.010
Adrian Diaz12
Estimated H-index: 12
(UM: University of Michigan),
Anghela Z. Paredes20
Estimated H-index: 20
(The Ohio State University Wexner Medical Center)
+ 1 AuthorsTimothy M. Pawlik121
Estimated H-index: 121
(The Ohio State University Wexner Medical Center)
Sources
Abstract
Abstract Background While variation in outcomes has driven centralization of complex cancer surgery, variation in cost and value remains unexplored. We evaluated outcomes relative to cost among hospitals performing esophageal and pancreatic resection for cancer. Methods Using 100% Medicare claims data, we identified fee-for-service Medicare patients undergoing elective esophagectomy and pancreatectomy for cancer from 2014 to 2016. Risk- and reliability-adjusted, price-standardized payments for the surgical episode from admission through 30 days post discharge, as well as risk- and reliability-adjusted complication rates for each hospital, were calculated. Hospitals were separated into quintiles relative to payments and outcomes. Highest-value hospitals were defined as hospitals in the top 2 quartiles for both cost and outcomes. Results Among 11,586 Medicare beneficiaries who underwent a complex oncologic operation between 2014 and 2016, 66% had a pancreatic neoplasm, while 33% had an esophageal neoplasm. Overall, 31.1% patients underwent an operation at a high-value hospital. Among patients who underwent pancreatectomy, the risk-adjusted postoperative complication rate was 31.4% at the lowest-value hospitals vs 22.7% at highest-value hospitals (odds ratio: 0.57, 95% confidence interval 0.47–0.70). The esophagectomy, risk-adjusted postoperative complication rate was 48.3% at lowest-value hospitals versus 29.8% at highest-value hospitals (odds ratio: 0.36, 95% confidence interval 0.27–0.47). The average difference in episode cost of care for an esophagectomy at lowest- versus highest-value hospitals was 5,617; the difference for pancreatectomy was ,748. Conclusion There was wide variation in complication rates and average costs among lowest- versus highest-value hospitals performing esophagectomy and pancreatectomy for cancer. Even among highest quality hospitals, wide variation in average episode costs was noted. Surgeons should seek to better understand practice variation to standardize care and decrease variation in outcomes, utilization, and costs.
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#1Raymond A. Jean (Yale University)H-Index: 12
#2Tasce Bongiovanni (UCSF: University of California, San Francisco)H-Index: 7
Last. Cary P. GrossH-Index: 73
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Abstract Background As cancer payment models transition from fee-for-service towards payment "bundles" based on episodes of care, a deeper understanding of the costs associated with stage I lung cancer treatment becomes increasingly relevant. To better understand costs in early lung cancer care, we sought to characterize hospital-level variation in Medicare expenditure following lobectomy for stage I non-small cell lung carcinoma (NSCLC). Methods Patients who were diagnosed with stage I NSCLC fr...
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#1Adrian Diaz (UM: University of Michigan)H-Index: 12
#2Sarah Burns (OSU: Ohio State University)H-Index: 3
Last. Timothy M. Pawlik (The Ohio State University Wexner Medical Center)H-Index: 121
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BACKGROUND: While better outcomes at high-volume surgical centers have driven regionalization of complex surgical care, access to high-volume centers often requires travel over longer distances. We sought to evaluate travel patterns of patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer to assess willingness of patients to travel for surgical care. METHODS: The California Office of Statewide Health Planning database was used to identify patients who underwent PD between 2005 a...
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#1Sarah B. Bateni (UC Davis: University of California, Davis)H-Index: 9
#2Alicia A. Gingrich (UC Davis: University of California, Davis)H-Index: 8
Last. Richard J. Bold (UC Davis: University of California, Davis)H-Index: 48
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Importance Value-based care is increasingly important, with rising health care costs and advances in cancer treatment leading to greater survival for patients with cancer. Regionalization of surgical care for pancreatic cancer has been extensively studied as a strategy to improve perioperative outcomes, but investigation of long-term outcomes relative to health care costs (ie, value) is lacking. Objective To identify patient and hospital characteristics associated with improved overall survival,...
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#1Katiuscha Merath (The Ohio State University Wexner Medical Center)H-Index: 21
#2Qinyu Chen (The Ohio State University Wexner Medical Center)H-Index: 15
Last. Timothy M. Pawlik (The Ohio State University Wexner Medical Center)H-Index: 121
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Abstract Background The focus of the current Medicare payment reform is to increase value – i.e. improve health care quality while lowering costs. This study sought to define cost variation and surgical quality among hospitals within small geographic areas typical of work commute patterns. Methods Medicare Provider Analysis and Review (MEDPAR) Inpatient Files was used to identify patients undergoing elective liver and pancreatic surgery between 2013 and 2015. Hospitals were assigned to combined ...
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#1Jay J. Idrees (The Ohio State University Wexner Medical Center)H-Index: 18
#2Brad F. Rosinski (The Ohio State University Wexner Medical Center)H-Index: 4
Last. Timothy M. Pawlik (The Ohio State University Wexner Medical Center)H-Index: 121
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Abstract Background Objectives were to determine the causes of readmission and assess the cost-effectiveness of high (HQ) and low quality (LQ) hospitals in performing pancreatic resection, by using readmission rates as the measure of quality. Methods We identified 53,572 pancreatic resection cases from National Readmission Database from 2010 through 2014. Hospitals were risk adjusted and ranked based on readmission. Top 20% HQ hospitals having the lowest readmission rates were compared to the bo...
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#1Sarah B. Bateni (UC Davis: University of California, Davis)H-Index: 9
#2Jennifer L Olson (UC Davis: University of California, Davis)H-Index: 2
Last. Richard J. Bold (UC Davis: University of California, Davis)H-Index: 48
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© 2018, Society of Surgical Oncology. Background: Outcomes for pancreatic resection have been studied extensively due to the high morbidity and mortality rates, with high-volume centers achieving superior outcomes. Ongoing investigations include healthcare costs, given the national focus on reducing expenditures. Therefore, we sought to evaluate the relationships between pancreatic surgery costs with perioperative outcomes and volume status. Methods: We performed a retrospective analysis of 27,6...
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#1Elliot Wakeam (U of T: University of Toronto)H-Index: 14
#2George Molina (Harvard University)H-Index: 15
Last. Alex B. Haynes (Harvard University)H-Index: 29
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Background Health care costs are an important policy focus in the United States. The magnitude and drivers of variation in the costs of common operative procedures are not well understood. We sought to characterize variation in costs across hospitals. Methods We used data from the Nationwide Inpatient Sample from 2001–2011 for 5 elective operations: colectomy, coronary artery bypass graft, total knee arthroplasty, cesarean section, and lung resection. Hospitals were benchmarked for each using hi...
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#1Zhi Ven Fong (Harvard University)H-Index: 25
#2Andrew P. Loehrer (University of Texas MD Anderson Cancer Center)H-Index: 12
Last. David C. Chang (Harvard University)H-Index: 25
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Background A minimum-volume policy restricting hospitals not meeting the threshold from performing complex operation may increase travel burden and decrease spatial access to operation. We aim to identify vulnerable populations that would be sensitive to an added travel burden. Methods We performed a retrospective analysis of the database of the California Office of Statewide Health Planning and Development for patients undergoing pancreatectomy from 2005 to 2014. Number of hospitals bypassed wa...
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#1Hari Nathan (UM: University of Michigan)H-Index: 37
#2Jyothi R. Thumma (UM: University of Michigan)H-Index: 19
Last. Justin B. Dimick (UM: University of Michigan)H-Index: 94
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Objective:We sought to assess hospital cost variation for elective inpatient surgical procedures within small geographic areas.Summary Background Data:Previous studies have documented cost variation for inpatient surgical procedures on a national basis, suggesting opportunities for savings. Cost var
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#1Faiz Gani (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 26
#2Fabian M. Johnston (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 24
Last. Timothy M. Pawlik (OSU: Ohio State University)H-Index: 121
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Background Data evaluating the financial implications of volume-based referral are lacking. This study sought to compare in-hospital costs for pancreatic surgery by annual hospital volume.
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#1Adrian Diaz (The Ohio State University Wexner Medical Center)H-Index: 12
#2J. Madison HyerH-Index: 18
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Objective We sought to characterize the association between patient county-level vulnerability with postoperative outcomes. Summary background data While the impact of demographic-, clinical- and hospital-level factors on outcomes following surgery have been examined, little is known about the effect of a patient's community of residence on surgical outcomes. Methods Individuals who underwent colon resection, coronary artery bypass graft (CABG), lung resection, or lower extremity joint replaceme...
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#1Adrian Diaz (UM: University of Michigan)H-Index: 12
#2Joal D. Beane (The Ohio State University Wexner Medical Center)H-Index: 23
Last. Timothy M. Pawlik (The Ohio State University Wexner Medical Center)H-Index: 121
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Abstract null null Background null We sought to define the impact of high- versus low-quality hospitals on the risk of adverse outcomes among patients undergoing hepatopancreatic surgery relative to social vulnerability. Social vulnerability is an important factor associated with risk of adverse postoperative outcomes. null null null Methods null Patients from 2013 to 2017 were identified from the Medicare Inpatient Standard Analytic File. Hospital quality was determined by calculating risk-adju...
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#2Mustapha AdhamH-Index: 26
Last. Yohan Fayet (French Institute of Health and Medical Research)
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#2Eric Felli (University of Bern)H-Index: 5
Last. Emanuele Felli (UDS: University of Strasbourg)H-Index: 13
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PURPOSE The hepato-mesenteric trunk is an extremely rare condition in which the common hepatic artery (CHA) originates from the superior mesenteric artery (SMA). Usually, CHA passes behind the head of the pancreas. A systematic review was performed to provide guidelines for the perioperative management of patients with this anatomical variation who underwent a pancreaticoduodenectomy (PD). A case report was also included. METHODS A systematic search of the literature was conducted and the manusc...
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#1Rohan Shah (OSU: Ohio State University)H-Index: 1
#2Adrian Diaz (UM: University of Michigan)H-Index: 12
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BACKGROUND: There has been a dramatic increase in worldwide health care spending over the last several decades. Operative procedures and perioperative care in the USA represent some of the most expensive episodes per patient. In view of both the rising cost of health care in general and the rising cost of surgical care specifically, policymakers and stakeholders have sought to identify ways to increase the value-improving quality of care while controlling (or diminishing) costs. In this context,...
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