Nav: Home

Study finds wide hospital variation in medicare expenditures to treat surgical complications

October 05, 2016

In a study published online by JAMA Surgery, Jason C. Pradarelli, M.D., M.S., of Brigham and Women's Hospital, Boston, and colleagues evaluated differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery.

Surgical complications are expensive events for patients, hospitals, and payers. The costs associated with rescuing patients from perioperative complications are poorly understood. In this study, the researchers used claims data from the Medicare Provider Analysis and Review files and 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 nationwide. The study included Medicare patients age 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.

The average age for Medicare beneficiaries in this study ranged from 74 years (pulmonary resection) to 78 years (colectomy); 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, the researchers found that payments for patients who were rescued (who survived following complications) 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 ($60,456 vs $23,261), colectomy ($56,787 vs $22,853), pulmonary resection ($63,117 vs $21,325), and total hip replacement ($41,354 vs $19,028).

Compared with lowest cost-of-rescue hospitals, highest cost-of-rescue hospitals had higher risk-adjusted rates of serious complications with similar rates of failure to rescue and overall 30-day mortality.

"This study presents important considerations for emerging policy initiatives. While innovative reimbursement strategies, such as accountable care organizations and bundled payments, aim to reward cost-efficient hospitals that provide high-quality care, a concern is that surgical quality at expensive hospitals might decrease further if their reimbursements are reduced. However, this analysis suggests that steering patients away from these hospitals has the potential to both lower Medicare spending and improve the safety of surgical care for patients," the authors write.

"In this study, the lowest cost-of-rescue hospitals demonstrated lower rates of perioperative complications in general. Furthermore, these lower-cost hospitals did not sacrifice clinical quality when treating patients who did incur adverse events (i.e., their rates of failure to rescue were equivalent to rates at higher-cost hospitals). This study provides evidence for cost-efficiency while effectively treating patients with perioperative complications. Emerging payment policies that incentivize high-quality care at lower costs may lead to previously unforeseen benefits even when applied to surgical patients who experience costly complications."
-end-
(JAMA Surgery. Published online October 5, 2016. doi:10.1001/jamasurg.2016.3340. This study is available pre-embargo at the For The Media website.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To place an electronic embedded link to this study in your story: This link will be live at the embargo time: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2016.3340

The JAMA Network Journals

Related Hospitals Articles:

'Five star' hospitals often provide fewer services than other hospitals, new data suggests
If you're looking for a top-notch hospital with a wide range of services, narrowing your list to hospitals with a five-star patient experience rating might lead you astray.
Costs of care similar or lower at teaching hospitals compared to non-teaching hospitals
Total costs of care are similar or somewhat lower among teaching hospitals compared to non-teaching hospitals among Medicare beneficiaries treated for common medical and surgical conditions, according to a new study led by researchers from Harvard T.H.
How common, preventable are sepsis-associated deaths in hospitals?
This study estimates how common sepsis-related deaths are in hospitals and how preventable those deaths might be.
Veterans health administration hospitals outperform non-VHA hospitals in most markets
In a new study, researchers from The Dartmouth Institute for Health Policy and Clinical Practice and the White River Junction VA Medical Center in White River Junction, Vermont, used the most current publicly available data to compare health outcomes for VA and non-VA hospitals within 121 local healthcare markets that included both a VA medical center and a non-VA hospital.
Tele-ERs can help strengthen rural hospitals
A new study from the University of Iowa finds rural hospitals that use tele-medicine to back up their emergency room health care providers save money and find it easier to recruit new physicians.
Hospitals may take too much of the blame for unplanned readmissions
A new study out of Beth Israel Deaconess Medical Center reveals that the preventability of readmissions changes over time: readmissions within the first week after discharge are often preventable by the hospital, whereas readmissions later are often related to patients' difficultly accessing outpatient clinics.
Hospitals often missing dementia despite prior diagnosis
Hospitals in the UK are increasingly likely to recognize that a patient has dementia after they've been admitted for a different reason, finds a new UCL-led study, but it is still only recognized in under two-thirds of people.
New strategies for hospitals during mass casualty incidents
Using the layout of a typical urban hospital, the authors investigated a hospital's capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assessed the effectiveness of designed demand management and capacity-expansion strategies.
Scottish hospitals see slower decline in deaths
In a first-of-its-kind study, the researchers looked at extensive data on hospital admissions and discharges in both countries over a 17-year period.
Patients with atrial fibrillation at greater risk of death in rural hospitals than urban hospitals
Patients with atrial fibrillation (AF) admitted to rural hospitals in the United States have a greater chance of dying during their hospital stay than patients admitted to urban hospitals for the same condition, according to a new report in HeartRhythm.
More Hospitals News and Hospitals Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#541 Wayfinding
These days when we want to know where we are or how to get where we want to go, most of us will pull out a smart phone with a built-in GPS and map app. Some of us old timers might still use an old school paper map from time to time. But we didn't always used to lean so heavily on maps and technology, and in some remote places of the world some people still navigate and wayfind their way without the aid of these tools... and in some cases do better without them. This week, host Rachelle Saunders...
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.