Ambulatory Surgery Centers and Outpatient Procedure Use Among Medicare Beneficiaries

Hollenbeck, Brent K.; Dunn, Rodney L.; Suskind, Anne M.; Zhang, Yun; Hollingsworth, John M.; Birkmeyer, John D.

doi:10.1097/mlr.0000000000000213

Cited by 68 publications

(58 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19 A recent trend has been early discharge of patients from hospital after surgical procedures, transitioning towards a more outpatient-based surgical paradigm. [20][21][22] Indeed, early hospital discharge for cancer patients expedites chemotherapy and/or radiotherapy and also potentially improves patient outcomes by decreasing the time period between surgery and resumption of daily activities. This trend towards early discharge has been somewhat resisted by many in the field of intracranial tumour surgery.…”

Section: Discussionmentioning

confidence: 99%

Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study

Venkatraghavan

Bharadwaj

et al. 2016

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose Enhanced Recovery After Surgery is a multimodal perioperative care pathway designed to achieve early discharge in patients undergoing major surgery. Recent advances in neurosurgery allow for shorter duration of anesthesia and surgery, faster recovery, and earlier discharge from hospital. The purpose of this retrospective observational study was to assess the incidence of early discharge from hospital in patients undergoing craniotomy for supratentorial brain tumours as well as to explore the associated perioperative factors, anesthesia techniques, and complications. Methods The medical records of all patients who underwent craniotomy (less than four-hour duration) for supratentorial tumour over a five-year period were retrospectively reviewed. The data analyzed included the postoperative discharge destination, type of anesthesiai.e., general anesthesia (GA) vs awake craniotomy (AC), and the incidence of adverse events. Results Data from 329 patients [mean (SD) age 48 (12) yr; 164 male, 165 female] were analyzed, including 198 (AC, n = 157; GA, n = 41) patients who were preoperatively

show abstract

Section: Discussionmentioning

confidence: 99%

Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study

Venkatraghavan

Bharadwaj

et al. 2016

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…The majority of physicians included in the analysis were male (95.9% [n ¼ 5430]) and practiced in urban locations (92.6% [n ¼ 5243]; Table II). The median number of years in practice was 23 years (IQR, 16-30 years), and the median number of patients who received a new diagnosis of claudication during the study period was 22 (IQR, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Patient and physician characteristics associated with early PVI. Based on univariable logistic regression analysis, patient characteristics associated with higher early PVI rates included age 65 to 74 years, male sex, hypertension, and smoking (all P < .001; Table III).…”

Section: Resultsmentioning

confidence: 99%

“…24 This must be considered in the broader context of ASC utilization for Medicare beneficiaries. Hollenbeck et al 25 found that rather than redistributing patients from hospital settings to ASCs, outpatient surgery rates in areas where ASCs were opened increased by 10.9% between 2001 and 2010, which was significantly higher than the 2.4% increase where ASCs were already present and 0.6% increase in areas where ASCs were never present. In another study of Medicare claims for endovascular interventions, there was a 298% increase in atherectomy cases in the OBL setting from 2011 to 2014 compared with a 27% increase in the hospital outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Overuse of early peripheral vascular interventions for claudication

Hicks

Holscher

Wang

et al. 2020

Journal of Vascular Surgery

View full text Add to dashboard Cite

Objective: Guidelines from the Society for Vascular Surgery and the Choosing Wisely campaign recommend that peripheral vascular interventions (PVIs) be limited to claudication patients with lifestyle-limiting symptoms only after a failed trial of medical and exercise therapy. We sought to explore practice patterns and physician characteristics associated with early PVI after a new claudication diagnosis to evaluate adherence to these guidelines. Methods:We used 100% Medicare fee-for-service claims to identify patients diagnosed with claudication for the first time between 2015 and 2017. Early PVI was defined as an aortoiliac or femoropopliteal PVI performed within 6 months of initial claudication diagnosis. A physician-level PVI utilization rate was calculated for physicians who diagnosed >10 claudication patients and performed at least one PVI (regardless of indication) during the study period. Hierarchical multivariable logistic regression was used to identify physician-level factors associated with early PVI.Results: Of 194,974 patients who had a first-time diagnosis of claudication during the study period, 6286 (3.2%) underwent early PVI. Among the 5664 physicians included in the analysis, the median physician-level early PVI rate was low at 0% (range, 0%-58.3%). However, there were 320 physicians (5.6%) who had an early PVI rate $14% ($2 standard deviations above the mean). After accounting for patient characteristics, a higher percentage of services delivered in ambulatory surgery center or office settings was associated with higher PVI utilization (vs 0%-22%; 23%-47%: adjusted odds ratio [aOR], 1.23; 48%-68%: aOR, 1.49; 69%-100%: aOR, 1.72; all P < .05). Other risk-adjusted physician factors independently associated with high PVI utilization included male sex (aOR, 2.04), fewer years in practice (vs $31 years; 11-20 years: aOR, 1.23; 21-30 years: aOR, 1.13), rural location (aOR, 1.25), and lower volume claudication practice (vs $30 patients diagnosed during study period; #17 patients: aOR, 1.30; 18-29 patients: aOR, 1.35; all P < .05). Conclusions:Outlier physicians with a high early PVI rate for patients newly diagnosed with claudication are identifiable using a claims-based practice pattern measure. Given the shared Society for Vascular Surgery and Choosing Wisely initiative goal to avoid interventions for first-line treatment of claudication, confidential data-sharing programs using national benchmarks and educational guidance may be useful to address high utilization in the management of claudication. (J Vasc Surg 2020;71:121-30.)

show abstract

“…; Hollenbeck et al. ). Importantly, this growth appears to be driven by procedures with less stringent clinical indications for their use (Hollingsworth et al.…”

Section: Commentmentioning

confidence: 98%

“…Third, physician owners preferentially manage well-insured patients (Gabel et al 2008) and perform well-reimbursed procedures (Plotzke and Courtemanche 2011) at ASCs. Finally, the opening of an ASC in a health care market has been associated with significantly higher rates of outpatient surgery relative to markets without them (Hollingsworth et al 2011;Hollenbeck et al 2014). Importantly, this growth appears to be driven by procedures with less stringent clinical indications for their use (Hollingsworth et al 2011).…”

Section: Commentmentioning

confidence: 99%