Raymond A Jean1, Tasce Bongiovanni2, Pamela R Soulos3, Alexander S Chiu4, Jeph Herrin5, Nancy Kim6, Xiao Xu7, Anthony W Kim8, Cary P Gross9. 1. Department of Surgery, Yale School of Medicine, New Haven, Connecticut; National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. 2. Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California. 3. Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut. 4. Department of Surgery, Yale School of Medicine, New Haven, Connecticut. 5. Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut; Health Research and Educational Trust, Chicago, Illinois. 6. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, New Haven, Connecticut. 7. Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut. 8. Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California. 9. National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Yale University Cancer Center, New Haven, Connecticut. Electronic address: cary.gross@yale.edu.
Abstract
BACKGROUND: As cancer payment models transition from fee for service toward payment "bundles" based on episodes of care, a deeper understanding of the costs associated with stage I lung cancer treatment becomes increasingly relevant. To better understand costs in early lung cancer care, we sought to characterize hospital-level variation in Medicare expenditure after lobectomy for stage I non-small cell lung carcinoma. METHODS: Patients who were diagnosed with stage I non-small cell lung carcinoma from 2006 through 2011 and undergoing lobectomy were selected from the Surveillance, Epidemiology and End Results-Medicare linked database. We used Medicare claims to estimate costs of care in the 90 days after initial surgical hospitalization. Hospitals were grouped into quintiles of mean excess cost, calculated as the mean difference between observed costs and risk-adjusted predicted costs. The association between hospital factors and mean excess cost were compared across hospitals, including complication rates and hospital volume. RESULTS: A total of 3530 patients underwent lobectomy at 156 hospitals. Hospitals in the lowest cost quintile had index hospitalizations $6226 less costly than predicted. Conversely, the most expensive hospital quintile had index hospital costs that were $6151 costlier than predicted. Increased costs were positively associated with the number of complications per patient (P < .001), but not hospital volume (P = .85). CONCLUSIONS: Among Medicare beneficiaries undergoing lobectomy for stage I non-small cell lung carcinoma, the cost of perioperative care varied substantially across hospitals and was strongly associated with complication rate, but not hospital volume.
BACKGROUND: As cancer payment models transition from fee for service toward payment "bundles" based on episodes of care, a deeper understanding of the costs associated with stage I lung cancer treatment becomes increasingly relevant. To better understand costs in early lung cancer care, we sought to characterize hospital-level variation in Medicare expenditure after lobectomy for stage I non-small cell lung carcinoma. METHODS:Patients who were diagnosed with stage I non-small cell lung carcinoma from 2006 through 2011 and undergoing lobectomy were selected from the Surveillance, Epidemiology and End Results-Medicare linked database. We used Medicare claims to estimate costs of care in the 90 days after initial surgical hospitalization. Hospitals were grouped into quintiles of mean excess cost, calculated as the mean difference between observed costs and risk-adjusted predicted costs. The association between hospital factors and mean excess cost were compared across hospitals, including complication rates and hospital volume. RESULTS: A total of 3530 patients underwent lobectomy at 156 hospitals. Hospitals in the lowest cost quintile had index hospitalizations $6226 less costly than predicted. Conversely, the most expensive hospital quintile had index hospital costs that were $6151 costlier than predicted. Increased costs were positively associated with the number of complications per patient (P < .001), but not hospital volume (P = .85). CONCLUSIONS: Among Medicare beneficiaries undergoing lobectomy for stage I non-small cell lung carcinoma, the cost of perioperative care varied substantially across hospitals and was strongly associated with complication rate, but not hospital volume.
Authors: Ryan P Merkow; Ying Shan; Aakash R Gupta; Anthony D Yang; Pradeep Sama; Mark Schumacher; David Cooke; Cynthia Barnard; Karl Y Bilimoria Journal: Jt Comm J Qual Patient Saf Date: 2020-07-03