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World Journal of Surgery
Published in: World Journal of Surgery 9/2018

01-09-2018 | Original Scientific Report

Hospital Teaching Status and Medicare Expenditures for Hepato-Pancreato-Biliary Surgery

Authors: Qinyu Chen, Fabio Bagante, Katiuscha Merath, Jay Idrees, Eliza W. Beal, Jordan Cloyd, Mary Dillhoff, Carl Schmidt, Adrian Diaz, Susan White, Timothy M. Pawlik

Published in: World Journal of Surgery | Issue 9/2018

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Abstract

Background

The association of hospital teaching status and overall expenditures has not been studied among patients undergoing hepato-pancreato-biliary (HPB) surgery. We sought to define the impact of hospital teaching intensity on payments and charges associated with (HPB) surgery from the payer perspective.

Methods

Surgical patients undergoing HPB procedures were identified using 2013–2015 Medicare Provider Analysis and Review (MEDPAR) data. Hospital teaching intensity was categorized based on hospital resident-to-bed ratio: non-teaching (NTH: 0), minor teaching (minor-TH: 0–0.363), and major teaching (major-TH:  > 0.363). Risk-adjusted price-standardized Medicare payments were assessed and compared among HPB surgical patients at NTH versus major-TH.

Results

A total of 8863 patients underwent HPB (NTH: n = 1239, 14.0%; minor-TH: n = 3202, 36.1%; major-TH: n = 4422, 49.9%). Patient comorbidities did not vary across hospital according to teaching intensity (p = 0.27). Mean risk-adjusted Medicare payment at a major-TH was $29,541 versus $19,345 at a NTH (Δ-payment: + $10,195; p < 0.001). Differences in Medicare payments associated with hospital teaching status persisted when the risk-adjusted price was standardized to remove social subsidies and regional variation in costs (NTH: $19,760 vs. major-TH: $28,382; Δ-payment:  + $8623). Major-TH had higher total charges submitted to Medicare versus NTH (NTH: $100,583 vs. major-TH: $120,498; Δ-charge = + $19,915), including charges for accommodations, laboratory, and blood utilization (all p < 0.05). Compared with NTH, major-TH had lower morbidity (22.6 vs. 19.0%), serious complications (13.0 vs. 10.5%) and 30-day mortality (4.8 vs. 2.3%) (all p < 0.05).

Conclusions

Major-TH was associated with higher Medicare expenditures than NTH among HPB surgical patients. These differences were attributable, in part, to higher submitted charges for hospital-based services. While associated with higher payments and charges, TH did have better short-term outcomes compared with NTH.
Appendix
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Metadata
Title
Hospital Teaching Status and Medicare Expenditures for Hepato-Pancreato-Biliary Surgery
Authors
Qinyu Chen
Fabio Bagante
Katiuscha Merath
Jay Idrees
Eliza W. Beal
Jordan Cloyd
Mary Dillhoff
Carl Schmidt
Adrian Diaz
Susan White
Timothy M. Pawlik
Publication date
01-09-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 9/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4566-1

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