Hospital Quality and Medicare Expenditures for Bariatric Surgery in the United States.
Hospital Quality and Medicare Expenditures for Bariatric Surgery in the United States.
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DOI：
10.1097/sla.0000000000001980
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发表时间：
2017-07
影响因子：
9
通讯作者：
Dimick JB
中科院分区：
文献类型：
--
作者：
Ibrahim AM;Ghaferi AA;Thumma JR;Dimick JB
作为美国最常见的外科手术之一，减肥手术是旨在降低手术成本的政策改革的主要焦点。这些政策机制使得了解质量改进计划的潜在成本节约势在必行。我们对2011年至2013年间接受减肥手术的38374名医疗保险受益人进行了回顾性审查。我们根据风险和可靠性调整后的术后严重并发症将医院分为五分之一。然后，我们检查了上、下结果五分位数与风险调整后总费用之间的关系。此外，我们根据患者发生并发症的风险（低、中、高）对患者进行分层，以了解这对支付的影响。我们发现医院并发症发生率和发作费用之间有很强的相关性。例如，并发症发生率最低的五分之一医院的平均总费用比最高的五分之一医院的每名患者少1,321美元（11,112美元对12,433美元，P<0.005）。成本节约在高风险患者中更为突出，最低五分位数医院和最高五分位数医院的每例患者总付款差异为2,160美元（12,960美元对15,120美元；P<0.005）。除了节省总费用外，与并发症发生率最高的医院相比，并发症发生率最低的医院在指数住院、再入院、医生服务和出院后辅助护理方面的成本也有所降低。在并发症发生率低的医院，医疗保险对减肥手术的支付要低得多。这些发现表明，努力提高减肥手术质量可能最终有助于降低成本。此外，这些成本节约可能在并发症风险最高的患者中最为突出。在并发症发生率低的医院，医疗保险对减肥手术的支付要低得多。此外，这些节省的费用可能在并发症风险最高的患者中最为突出。
To examine the relationship between hospital outcomes and expenditures in patients undergoing bariatric surgery in the United States As one of the most common surgical procedures in the United States, bariatric surgery is a major focus of policy reforms aimed at reducing surgical costs. These policy mechanisms have made it imperative to understand the potential cost savings of quality improvement initiatives. We performed a retrospective review of 38,374 Medicare beneficiaries undergoing bariatric surgery between 2011 and 2013. We ranked hospitals into quintiles by their risk- and reliability-adjusted post-operative serious complications. We then examined the relationship between upper and lower outcome quintiles with risk-adjusted, total episode payments. Additionally, we stratified patients by their risk (low, medium, high) of developing a complication to understand how this impacted payment. We found a strong correlation between hospital complication rates and episode payments. For example, hospitals in the lowest quintile of complication rates had average total episode payments that were $1,321 per patient less than hospitals in the highest quintile ($11,112 versus $12,433, P<0.005). Cost savings was more prominent amongst high risk patients where the difference of total episode payments per patient between lowest and highest quintile hospitals was $2,160 ($12,960 versus $15,120; P<0.005). In addition to total episode payment savings, hospitals with the lowest complication rates also had decreased costs for index hospitalization, readmissions, physician services and post-discharge ancillary care compared to hospitals with the highest complication rates. Medicare payments for bariatric surgery are significantly lower at hospitals with low complication rates. These findings suggest that efforts to improve bariatric surgical quality may ultimately help reduce costs. Additionally, these cost savings may be most prominent amongst the patients at the highest risk for complications. Medicare payments for bariatric surgery are significantly lower at hospitals with low complication rates. Additionally, these costs savings may be most prominent amongst the patients at the highest risk for complications.