PD32-07 EVIDENCE IN SUPPORT OF USING A SINGULAR SCORE TO CHARACTERIZE A SURGEON′S OPERATIVE SPENDING BEHAVIOR

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures III1 Apr 2017PD32-07 EVIDENCE IN SUPPORT OF USING A SINGULAR SCORE TO CHARACTERIZE A SURGEON′S OPERATIVE SPENDING BEHAVIOR Matthew Truesdale, Christy Boscardin, and Thomas Chi Matthew TruesdaleMatthew Truesdale More articles by this author , Christy BoscardinChristy Boscardin More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1398AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cost-control initiatives targeting physicians are currently underway to improve cost-efficient clinical care. Little is known regarding surgeon-specific cost choices. We sought to characterize surgeon periorperative spending to evaluate the accuracy of a singular score summarizing surgeon cost-efficiency. METHODS All surgeons operating at UCSF Medical Center from July 2012-October 2015 across all specialties were included. Mean OR cost was calculated combining surgical supplies and time in the OR ($/minute). Cases were included if ≥ 4 surgeons performed said operation and all included surgeons completed ≥ 20 operations. Z-scores, defined as [(cost of surgeon′s case) - (median cost for said case across all surgeons)] / [standard deviation (SD) of all surgeons′ costs for said case], were calculated for each surgeon and surgical case performed. Estimated mean z-scores were then calculated using mixed effects modeling. Surgeons′ z-score variability was evaluated using calculated SDs. RESULTS 257 surgeons across 17 surgical subspecialties were included in the analysis. The mean raw z-score was -0.12 ranging from -1.85 to 3.4 with SD of 0.78. The estimated z-score variability across the surgeons ranged from -0.5 to 0.5 SDs from the average estimated z-score (Figure 1). When comparing surgical subspecialties, the variability of z-scores ranged from 0.06 to -0.07. In individual subspecialties, the variability (SD) ranged from 0.25 to 0.02. CONCLUSIONS The z-score variability across all surgeons was small, supporting consistent surgeon-spending behavior across diverse cases. This supports using a surgeon′s estimated mean z-score as a singular and accurate metric characterizing surgeons′ cost behavior. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e591 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Matthew Truesdale More articles by this author Christy Boscardin More articles by this author Thomas Chi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...