Association of Hospital Market Concentration With Costs of Complex Hepatopancreaticobiliary Surgery

Cerullo, Marcelo; Chen, Sophia Y.; Dillhoff, Mary; Schmidt, Carl; Canner, Joseph K.; Pawlik, Timothy M.

doi:10.1001/jamasurg.2017.2158

Cited by 29 publications

(29 citation statements)

References 43 publications

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“…Another reason could be that due to fears of malpractice/litigation, providers are more likely to practice defensive medicine in the Northeast and West, which can also increase the costs-ofcare. Low hospital market competition [33] or high hospital market concentration [34] and limited number of medical providers/services in certain remote states, such as Alaska, may be another reason for the significantly higher costs-of-care noted in these regions. Regardless of the causes/reasons, acknowledging and risk-adjusting payments to account for state-level variations would an important step in mitigating the development of inequitable care, barriers to access and financial disincentives in bundled payment models.…”

Section: Discussionmentioning

confidence: 99%

Are current DRG-based bundled payment models for lumbar fusions risk-adjusting adequately? An analysis of Medicare beneficiaries

Malik

Phillips

et al. 2020

The Spine Journal

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Section: Discussionmentioning

confidence: 99%

Are current DRG-based bundled payment models for lumbar fusions risk-adjusting adequately? An analysis of Medicare beneficiaries

Malik

Phillips

et al. 2020

The Spine Journal

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“…However, the results are far from conclusive. Claims have been made to two extremes: some studies argue that competition in the health care sector is effective, resulting in lowered medical expenses [7–9], while others failed to reveal an association between hospital competition and medical expenses [10–14].…”

Section: Introductionmentioning

confidence: 99%

Hospital competition and the expenses for treatments of acute and non-acute common diseases: evidence from China

Deng

Pan

2019

BMC Health Serv Res

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BackgroundBecause there is heterogeneity in disease types, competition among hospitals could be influenced in various ways by service provision for diseases with different characteristics. Limited studies have focused on this matter. This study aims to evaluate and compare the relationships between hospital competition and the expenses of prostatectomies (elective surgery, representing treatments of non-acute common diseases) and appendectomies (emergency surgery, representing treatments of acute common diseases).MethodsMultivariable log-linear models were constructed to determine the association between hospital competition and the expenses of prostatectomies and appendectomies. The fixed-radius Herfindahl-Hirschman Index was employed to measure hospital competition.ResultsWe collected data on 13,958 inpatients from the hospital discharge data of Sichuan Province in China from September to December 2016. The data included 3578 prostatectomy patients and 10,380 appendectomy patients. The results showed that greater competition was associated with a lower total hospital charge for prostatectomy (p = 0.006) but a higher charge for appendectomy (p < 0.001). The subcategory analysis showed that greater competition was consistently associated with lower out-of-pocket (OOP) and higher reimbursement for both surgeries.ConclusionsGreater competition was significantly associated with lower total hospital charges for prostatectomies, while the opposite was true for appendectomies. Furthermore, greater competition was consistently associated with lower OOP but higher reimbursement for both surgeries. This study provides new evidence concerning the heterogeneous roles of competition in service provision for non-acute and acute common diseases. The findings of this study indicate that the pro-competition policy is a viable option for the Chinese government to relieve patients’ financial burden (OOP). Our findings also provide references and insights for other countries facing similar challenges.

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“…Geographic cost variation is a known consideration in cost analysis studies using data from the USA, and the northeastern regions (New England, Middle Atlantic) have the highest reported mean costs of stay and mean lengths of stay 23. These findings have been reproduced in similar nationwide analyses of surgical patients, and explanations remain inconclusive but include cost of living differences, degree of regulatory control and differences in admission diagnoses 24–26. In emergency and trauma surgery, regional variation also persists but tends to be less consistent with different regions leading costs for different admission diagnoses 27…”

Section: Discussionmentioning

confidence: 86%

Variation in the use of MRI for cervical spine clearance: an opportunity to simultaneously improve clinical care and decrease cost

Albaghdadi

Leeds

Florecki

et al. 2019

Trauma Surg Acute Care Open

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BackgroundFor years, controversy has existed about the ideal approach for cervical spine clearance in obtunded, blunt trauma patients. However, recent national guidelines suggest that MRI is not necessary for collar clearance in these patients. The purpose of this study was to identify the extent of national variation in the use of MRI and assess patient-specific and hospital-specific factors associated with the practice.MethodsWe performed a retrospective review of the National Trauma Data Bank from 2007 to 2012. We included blunt trauma patients aged ≥18 years, admitted to level 1 or 2 trauma centers (TCs), with a Glasgow Coma Scale <8, Abbreviated Injury Scale >3 for the head and mechanically ventilated for more than 72 hours. Multilevel modeling was used to identify patient-level and hospital-level factors associated with spine MRI use.Results32 125 obtunded, blunt trauma patients treated at 395 unique TCs met our inclusion criteria. The mean proportion of patients who received MRI over the entire sample was 9.9%. The proportions of patients at each hospital who received a spine MRI ranged from 0.5% to 68.7%. Younger patients, with injuries from motor vehicle collisions and pedestrian injuries, were more likely to receive MRI. When controlling for other variables, Injury Severity Score (ISS) was not associated with MRI use. Hospitals in the Northeast, level 1 TCs and non-teaching hospitals were more likely to obtain MRIs in this patient population.ConclusionAfter controlling for patient-level characteristics, variation remained in MRI use based on geography, trauma center level and teaching status. This evidence suggests that current national guidelines limiting the use of MRI for cervical spine evaluation following blunt trauma are not being followed consistently. This may be due to physicians not being up to date with best practice care, unavailability of locally adopted protocols in institutions or lack of consensus among clinical providers.Level of evidencePrognostic and epidemiological, level III.

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Association of Hospital Market Concentration With Costs of Complex Hepatopancreaticobiliary Surgery

Abstract: Higher market concentration was associated with lower overall charges and lower costs of pancreatic and hepatic surgery. For complex, highly specialized procedures, hospital market consolidation may represent the best value proposition: better quality of care with lower costs.

Cited by 29 publications

References 43 publications

Are current DRG-based bundled payment models for lumbar fusions risk-adjusting adequately? An analysis of Medicare beneficiaries

Are current DRG-based bundled payment models for lumbar fusions risk-adjusting adequately? An analysis of Medicare beneficiaries

Hospital competition and the expenses for treatments of acute and non-acute common diseases: evidence from China

Variation in the use of MRI for cervical spine clearance: an opportunity to simultaneously improve clinical care and decrease cost

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