Hospital quality, patient risk, and Medicare expenditures for cancer surgery.
Hospital quality, patient risk, and Medicare expenditures for cancer surgery.
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医院质量、患者风险和癌症手术的医疗保险支出。
作者：
Shubeck,SarahP;Thumma,JyothiR;Dimick,JustinB;Nathan,Hari
手术切除是实体器官恶性肿瘤患者治疗的基石。随着人们对手术护理费用的关注日益增加，人们开始关注癌症手术费用的变化。本研究评估了医院质量和患者风险对癌症切除术支出的潜在交互作用。METHODS与100%医疗保险索赔数据为2010 - 2013年，患者年龄在65至99岁谁经历了癌症切除术进行了鉴定。医疗保险支付计算从指数入院到出院后30天的手术事件。评估了手术后30天内严重并发症和死亡率的风险和可靠性调整医院率，以将高质量和低质量医院分类。在质量最差的医院进行的每项手术的开支都有大幅度增加。所有患者在最低质量医院的支出增加，但风险最高的患者的支出最高。在低质量医院，接受胰腺切除术的低风险患者的费用为29，080美元，而高风险患者的平均费用为62，687美元;这是每例患者33，607美元的差异。结论在低并发症、高质量医院提供护理时，癌症切除术的总费用较低。高风险患者的费用差异特别大，这表明选择将高风险患者转移到高质量中心可能是优化癌症手术价值的有效策略。Cancer 2018;124：826 - 32.© 2017美国癌症协会。
BACKGROUNDSurgical resection is a cornerstone of curative‐intent therapy for patients with solid organ malignancies. With increasing attention paid to the costs of surgical care, there is a new focus on variations in the costs of cancer surgery. This study evaluated the potential interactive effect of hospital quality and patient risk on expenditures for cancer resections.METHODSWith 100% Medicare claim data for 2010‐2013, patients aged 65 to 99 years who had undergone cancer resection were identified. Medicare payments were calculated for the surgical episode from the index admission through 30 days after discharge. Risk‐and reliability‐adjusted hospital rates of serious complications and mortality within 30 days of the index operation were assessed to categorize high‐and low‐quality hospitals.RESULTSThere was no difference in patient characteristics between the highest and lowest quality hospitals. There were substantial increases in expenditures for procedures performed at the lowest quality hospitals for each procedure. Increased expenditures at the lowest quality hospitals were found for all patients, but they were highest for the highest risk patients. At low‐quality hospitals, low‐risk patients undergoing pancreatectomy had payments of 29,080,whereashigh‐riskpatientshadaveragepaymentsof 62,687; this was a difference of 33,607perpatientepisode.CONCLUSIONSTotalepisodeexpendituresforcancerresectionswerelowerwhencarewasdeliveredatlow‐complication,high‐qualityhospitals.Expendituredifferenceswereparticularlylargeforhigh‐riskpatients,andthissuggeststhattheselectivereferralofhigh‐riskpatientstohigh‐qualitycentersmaybeaneffectivestrategyforoptimizingvalueincancersurgery.Cancer2018;124:826‐32.©2017AmericanCancerSociety.