Total Episode Payments Research Articles

1542 EARLY SURGICAL INTERVENTION VS. MEDICAL EXPULSIVE THERAPY FOR RENAL COLIC

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20121542 EARLY SURGICAL INTERVENTION VS. MEDICAL EXPULSIVE THERAPY FOR RENAL COLIC Robert Matthew Smith, Samual Kaufman, Roberts William, Gary Faerber, Wolf Stuart, Hollenbeck Brent, and John Hollingsworth Robert Matthew SmithRobert Matthew Smith Ann Arbor, MI More articles by this author , Samual KaufmanSamual Kaufman Ann Arbor, MI More articles by this author , Roberts WilliamRoberts William Ann Arbor, MI More articles by this author , Gary FaerberGary Faerber Ann Arbor, MI More articles by this author , Wolf StuartWolf Stuart Ann Arbor, MI More articles by this author , Hollenbeck BrentHollenbeck Brent Ann Arbor, MI More articles by this author , and John HollingsworthJohn Hollingsworth Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Contemporary guidelines recommend a trial of medical expulsive therapy (MET) in patients with uncomplicated renal colic because MET may spare them from the risks of active stone removal. However, this benefit of MET may be mitigated by increased use of health services among patients awaiting stone passage. We sought to compare the resource utilization and costs per episode of early surgical intervention with a strategy of MET for patients with urinary stone disease. METHODS Using data from MarketScan® (2002-2006), we identified a cohort of patients with renal colic. Next, we determined whether each patient received early (i.e., within 3 days of diagnosis) ureteroscopy (URS) or a trial of MET. We then followed patients for 6 weeks and measured their frequency of emergency department (ED) revisit, inpatient admission, outpatient visit, and prescription fill. We assessed total and component episode payments made on their behalf. Finally, we used multivariable regression to examine the relationship between our outcomes of interest and the type of initial management. RESULTS As shown in the Table, patients managed with MET had fewer ED revisits (P<.0001), inpatient admissions (P<.0001) and outpatient visits (P<.0001), but more prescription fills (P<.0001) than those who underwent early surgery. Compared to active stone removal, an initial trial of MET was associated with lower payments for ED (P<.0001), inpatient (P<.0001), and outpatient care (P<.0001); however, its associated drug costs were higher (P<.0001). After adjusting for patient differences, MET use was associated with significantly lower total episode payments ($8,836 vs. $ 4,465, P<.0001). CONCLUSIONS Regarding resource utilization and episode costs, MET with eventual URS, if needed, appears more effective than early surgery for the initial management of acute renal colic. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e624 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Matthew Smith Ann Arbor, MI More articles by this author Samual Kaufman Ann Arbor, MI More articles by this author Roberts William Ann Arbor, MI More articles by this author Gary Faerber Ann Arbor, MI More articles by this author Wolf Stuart Ann Arbor, MI More articles by this author Hollenbeck Brent Ann Arbor, MI More articles by this author John Hollingsworth Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Healthcare Utilization in Community-Acquired Pneumonia Episodes of Care

Compare healthcare utilization and total payments for community-acquired pneumonia (CAP) episodes-of-care among 5 health plan designs spanning the continuum of managed care. Medical and prescription claims analysis of CAP episodes among enrollees of employer-sponsored health plans. Episode characteristics, healthcare utilization, and payments were compared across fee-for-service, Preferred Provider Organizations (PPO), point of service, partial capitation, and Health Maintenance Organizations as defined by the employers. Medstat Episode of Care Grouper Version 2.1.5 was employed to create episodes of CAP care. Categorical and continuous measures of patient and care characteristics across plan designs were compared by chi tests and one-way analysis-of-variance as appropriate. Total per-episode payments for provided services across plan designs were compared using a general linear model with a log-link function and gamma distribution. Greater average patient age, episode severity, number of office visits, rate of hospitalization, length of stay, and inpatient mortality overall were found within PPO episodes compared with all other plan designs. Total episode payments controlling for age, sex, disease severity, and geography were greatest among PPO episodes and attributed largely to more office visits and longer lengths of hospital stays compared with other plan types. As previously shown among other patient populations and conditions, PPO episodes of CAP are associated with greater total payments due in large part to increased resource utilization among the episodes of lowest severity.