The Use, Safety and Cost of Bariatric Surgery Before and After Medicare's National Coverage Decision
The Use, Safety and Cost of Bariatric Surgery Before and After Medicare's National Coverage Decision
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DOI：
10.1097/sla.0b013e31822f2101
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发表时间：
2011-12-01
影响因子：
9
通讯作者：
Sullivan, Sean D.
中科院分区：
文献类型：
--
作者：
Flum, David R.;Kwon, Steve;Sullivan, Sean D.
目的：确定医疗保险和医疗补助服务中心（CMS）减肥手术全国覆盖决定（NCD）对CMS受益人的使用、安全性和护理成本的影响。背景：2006年2月，CMS发布了一项NCD，将减肥手术的报销限制在经认证的中心，并包括腹腔镜可调节胃束带（LAGB）的覆盖范围。一项使用全国医疗保险数据的中断前/中断后时间序列队列研究（2004-2008）评估率的减肥手术/100，000登记，90天死亡率，再入院率和pays.Results：47030例患者进行了程序在928个网站前NCD和662后NCD。在非传染性疾病之后，每100 000名患者的手术率下降到17.8（从2005年的21.9），2007年和2008年分别增加到23.8和29.1。开放式Roux-en-Y胃旁路术（ORYGB）和腹腔镜Roux-en-Y胃旁路术（LRYGB）是NCD前常见的手术（56.0% ORYGB，35.5% LRYGB），NCD后改变为LAGB（12.8% ORYGB，48.7% LRYGB，36.7% LAGB）。90-NCD前的日死亡率为1.5%（ORYGB为1.8%，LRYGB为1.1%，NCD后为0.7%（ORYGB为1.7%，LRYGB为0.8%，LAGB为0.3%，P < 0.001）。NCD后90天再入院率下降（19.9%至15.4%），再次手术（3.2%至2.1%）和付款（24，363美元至19，746美元; P < 0.001）。结果和成本的差异在很大程度上解释了在程序类型和患者的characteristics.Conclusions：NCD与程序率的暂时降低和程序类型和患者接受减肥手术的转变。它与死亡、并发症、再入院和每位患者支付的风险显著降低相关。
Objective: To determine the impact of the Centers for Medicare and Medicaid Services' (CMS) bariatric surgery national coverage decision (NCD) on the use, safety, and cost of care CMS beneficiaries.Background: In February 2006, the CMS issued a NCD restricting reimbursement for bariatric surgery to accredited centers and including coverage for laparoscopic adjustable gastric band (LAGB).Methods: A pre/postinterrupted time-series cohort study using nationwide Medicare data (2004-2008) evaluating rates of bariatric procedures/100,000 enrollees, 90-day mortality, readmission rate and payments.Results: Forty-seven thousand thirty patients underwent procedures at 928 sites pre-NCD and 662 post-NCD. The procedure rate/100,000 patients dropped after the NCD to 17.8 (from 21.9 in 2005) increasing to 23.8 and 29.1 in 2007 and 2008, respectively. Open roux-en-y gastric bypass (ORYGB) and laparoscopic roux-en-y gastric bypass (LRYGB) were common pre-NCD (56.0% ORYGB, 35.5% LRYGB) changing post-NCD with LAGB inclusion (12.8% ORYGB, 48.7% LRYGB, 36.7% LAGB). 90-day mortality pre-NCD was 1.5% (1.8% ORYGB, 1.1% LRYGB) and post-NCD was 0.7% (1.7% ORYGB, 0.8% LRYGB, 0.3% LAGB; P < 0.001). The 90-day rates of readmission decreased post-NCD (19.9% to 15.4%), reoperation (3.2% to 2.1%) and payments ($ 24,363 to $ 19,746; P for all < 0.001). Differences in outcome and cost were largely explained by a shift in procedure type and patient characteristics.Conclusions: The NCD was associated with a temporary reduction in procedure rate and a shift in types of procedures and patients undergoing bariatric surgery. It was associated with a significant decrease in the risk of death, complications, readmissions, and per patient payments.