Hospital Teaching Status and Medicare Expenditures for Complex Surgery. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Pradarelli, Jason C.; Scally, Christopher P.; Nathan, Hari; Thumma, Jyothi R.; Dimick, Justin B.
• Is Part Of: Annals of surgery. Volume 265:Issue 3(2017:Mar.)
• Publication Date: 2017-03
• Subjects: Medicare payments -- perioperative outcomes -- surgical costs -- surgical quality -- teaching hospital -- value-based purchasing; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001706
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To evaluate the relationship between hospital teaching intensity, Medicare payments, and perioperative outcomes. Background: Several emerging payment policies penalize hospitals for low-value healthcare. Teaching hospitals may be at a disadvantage given the perception that they deliver care less efficiently. Methods: Using Medicare Provider and Analysis Review files, we studied patients from age 65 to 100 years who underwent abdominal aortic aneurysm (AAA) repair (n = 71, 422), pulmonary resection (n = 93, 056), or colectomy (n = 277, 619) from 2009 to 2012. Patients' hospitals were categorized into quintiles of teaching intensity (very major, major, minor, very minor, and nonteaching hospitals) based on the resident-to-bed ratio. Risk-adjusted 30-day Medicare payments were price-standardized to account for graduate medical education payments, disproportionate share costs, and regional wage-index adjustments. Risk-adjusted perioperative outcomes were also assessed. Results: Comparing risk-adjusted Medicare payments per episode of surgery, very major teaching hospitals were $14, 145 more expensive than nonteaching hospitals for AAA repair ($45, 570 vs $31, 426; P < 0.001), $9, 812 more expensive for pulmonary resection ($39, 550 vs $29, 738; P < 0.001), and $19, 147 more expensive for colectomy ($51, 893 vs $32, 746; P < 0.001). However, after accounting for social subsidies and regional variation in Medicare spending, risk-adjusted Medicare payments were not statistically different between very major teaching hospitals and nonteaching hospitals for AAA repair ($29, 946 vs $27, 993; P = 0.18) and pulmonary resection ($25, 407 vs $26, 813; P = 1.00); a statistically significant but attenuated difference persisted for colectomy ($34, 949 vs $30, 352; P < 0.001). Very major teaching hospitals generally had higher risk-adjusted rates of serious complications and readmissions, but lower risk-adjusted rates of failure to rescue and 30-day mortality than did nonteaching hospitals. Conclusions: After price-standardization to account for intended differences in Medicare spending, risk-adjusted Medicare payments for an episode of surgical care were similar at teaching hospitals and nonteaching hospitals for three complex inpatient operations. Abstract : Supplemental Digital Content is available in the text