Variation in Surgical Spending Among the Highest Quality Hospitals for Cancer Surgery

Abstract

Objective: This study evaluates the variation in spending by the highestquality hospitals performing complex cancer surgery in the United States. Summary Background Data: As mortality rates for high-risk cancer surgery have improved, increased attention has focused on other elements of quality, such as complications. However, high-value surgical care requires both high-quality care and cost savings. Therefore, understanding any residual cost variation among high-quality hospitals is essential to better direct efforts to achieve efficient, high-value care. Methods: Medicare beneficiaries age 65 to 99 who underwent surgery for pancreas, esophageal, lung, rectal, and colon cancer from 2014 to 2016 were identified. The highest-quality hospitals were identified as those in the quintile with the lowest risk-and reliability-adjusted serious complication rates for each operation. Within this cohort of high-quality hospitals, 30-day total episode, index hospitalization, physician, postacute care, and readmis-sion spending were analyzed. Logistic regression models were utilized to estimate the probability of postoperative outcomes and post-discharge resource utilization. Results: A total of 43,007 Medicare patients underwent either pancreas, esophageal, lung, rectal, or colon resection for cancer at a hospital within the highest-quality quintile.

Identifying Sources of Inter-Hospital Variation in Episode Spending for Sepsis Care

“…Our finding that postacute care is a major driver of spending variability for sepsis is consistent with evidence from several other surgical procedures and medical conditions 19–21 . Postacute care is the fastest growing source of Medicare expenditures, accounts for the largest component of geographic variation in spending among Medicare beneficiaries, and has previously been noted as a potential area of focus for spending reduction 22,23 .…”

“…Our finding that postacute care is a major driver of spending variability for sepsis is consistent with evidence from several other surgical procedures and medical conditions. [19][20][21] Postacute care is the fastest growing source of Medicare expenditures, accounts for the largest component of geographic variation in spending among Medicare beneficiaries, and has previously been noted as a potential area of focus for spending reduction. 22,23 For sepsis specifically, modification in post-acute care discharge practices as a means of spending reduction may be particularly alluring given that over a third of sepsis patients are currently discharged to postacute care facilities, and use of postacute care for sepsis patients has risen over time, possibly serving as a substitute for continued hospitalization.…”

Trends in Discharge Disposition Following Hepatectomy for Hepatocellular Carcinoma Among Medicare Beneficiaries

“…11 Rather, the high utilization of PAC services may account for the majority of the cost variation among hospitals performing complex cancer surgeries. 13 The factors associated with patient selection relative to PAC utilization and the utilization of different PAC services (i.e., home healthcare, long-term care hospitals, and skilled nursing facilities) have not been well-defined. 14 While several studies have evaluated postoperative outcomes among patients undergoing hepatic resection, trends in discharge disposition among patients following hepatectomy have not been investigated.…”