Podium Session

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PD14-03: POST-ACUTE CARE AS A DRIVER OF EPISODE COST VARIATION FOR AMBULATORY STONE SURGERY

Friday, May 12
3:50 PM - 4:00 PM
Location: BCEC: Room 162

Presentation Authors: John M. Hollingsworth*, Hechuan Hou, Jim Dupree, Ann Arbor, MI, Brian Seifman, West Bloomfield, MI, Adam Kadlec, Holland, MI, Anita Tekchandani, Midland, MI, David Leavitt, Detroit, MI, Khurshid Ghani, Ann Arbor, MI

Introduction: Because many post-acute care (PAC) services, including emergency department (ED) visits, after ambulatory stone surgery are potentially avoidable, they are coming under payer scrutiny. In this context, we analyzed claims data to describe variation in total episode costs for ambulatory stone surgery across a diverse set of hospitals, examining PAC as a driver of this variation.

Methods: We used Medicare and private insurer claims to identify patients who underwent ambulatory stone surgery (ureteroscopy or shockwave lithotripsy) at hospitals in Michigan (2012-2015) from the Michigan Value Collaborative. We defined surgical episodes that extended from the surgery date through 30 days post-discharge and totaled costs for all relevant services during this window. We then categorized component payments to the hospital for the index surgery, as well as those for professional services, subsequent hospitalizations, and PAC. Finally, after aggregating across episodes within a year by hospital, we placed hospitals into quartiles based on their mean total costs and compared component payments at high- versus low-cost hospitals.

Results: In total, we identified 7,807 patients who underwent ambulatory stone surgery at 69 hospitals in Michigan. The mean total cost for hospitals was $9,538 ($13,044 and $9,037 for episodes associated with and without an ED visit after surgery, respectively) and ranged from $7,317 to $11,914 across hospital quartiles (62.8% difference, P < .001). Payments were higher for hospitals in the highest cost quartile across all payment components (Figure). The index surgery payments contributed the most (64%) to the variation in total costs between high- and low-cost hospitals (Figure), followed by those for subsequent hospitalizations (13%), professional payments (12%), and PAC payments (11%).

Conclusions: We observed significant variation in total episode costs for ambulatory stone surgery, driven, in part, by payments for PAC. As such, efforts to reduce the use of PAC services, including ED visits, after ambulatory stone surgery is likely to improve cost-efficiency.

Source Of Funding: Blue Cross Blue Shield of Michigan

John M. Hollingsworth, MD, MS

University of MIchigan

Dr. Hollingsworth is an Associate Professor of Urology. He received his medical degree from Georgetown University's School of Medicine in 2002, and earned a Master of Science degree in Health and Healthcare Research through the University of Michigan's Horace H. Rackham School of Graduate Studies in 2006. Following completion of his urology residency training at Michigan (2002-2008), he entered the Robert Wood Johnson Foundation Clinical Scholars Program (2008-2010). He then joined the Michigan faculty in 2010. Dr. Hollingsworth's research has encompassed a broad range of health services disciplines. He has investigated the effect of financial incentives associated with physician ownership on procedure utilization. He has also examined the relationship between variation in provider practice and the quality and costs of urological care. His current line of inquiry explores the interface between primary and specialty care. With funding from the Agency for Healthcare Research and Quality, he is investigating how patterns of connection among surgeons, referring primary care physicians, and consultants impact the efficiency of care delivered around the surgical episode.

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