Abstract
ObjectivesThis study documents trends in risk-adjusted quality and cost for a variety of inpatient surgical procedures among Medicare beneficiaries from 2002 through 2015, which can provide valuable insight on future strategies to improve public health and health care.MethodsWe focused on 11 classes of inpatient surgery, defined by the Agency for Health Research and Quality’s (AHRQ’s) Clinical Classification System. The surgical classes studied included a wide range of surgeries, including tracheostomy, heart valve procedures, colorectal resection, and wound debridement, among others. For each surgical class, we assessed trends in treatment costs and quality outcomes, as defined by 30-day survival without unplanned readmissions, among Medicare beneficiaries receiving these procedures during hospital stays. Quality and costs were adjusted for patient severity based on demographics, comorbidities, and community context. We also explored surgical innovations of these 11 classes of inpatient surgery from 2002–2015.ResultsWe found significant improvements in quality for 7 surgical classes, ranging from 0.08% (percutaneous transluminal coronary angioplasty) to 0.74% (heart valve procedures) per year. Changes in cost varied by surgery, the significant decrease in cost ranged from -2.59% (tracheostomy) to -0.34% (colorectal resection) per year. Treatment innovation occurred with respect to surgical procedures utilized for heart valve procedures and colorectal resection, which may be associated with the decrease in surgical cost.ConclusionsOur results suggest that there was significant quality improvement for 7 surgery categories over the 14-year study period. Costs decreased significantly for 6 surgery categories, and increased significantly for 3 other categories.
Highlights
Controlling healthcare spending while simultaneously improving quality of service has been an ongoing effort in the US
Assistance for accessing and using these data is made available by the Research Data Assistance Center (ResDAC)
ResDAC is a consortium of faculty and staff from the University of Minnesota, Boston University, Dartmouth Medical School, and the Morehouse School of Medicine
Summary
Over the past several decades, the long-term changes in inpatient surgical quality and cost have been affected by a variety of factors, including physician skill, surgical knowledge, price of supplies, policy change, technology innovation, healthcare condition, etc. Policies introduced by the Centers for Medicare and Medicaid Services (CMS), such as the Hospital Value-Based Purchasing Program and Hospital Readmissions Reduction Program (HRRP), may strive to control hospital inpatient admissions, unplanned readmissions, and unnecessary costs [7,8,9], but at the same time may encourage development of new technologies that increase surgical costs. We aim to evaluate the value of inpatient surgical care by studying long-term changes in cost and quality outcomes, relative to patient illness severity and demographic information
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