TY - JOUR
T1 - Evaluating individual surgeons based on total hospital costs
T2 - Evidence for variation in both total costs and volatility of costs
AU - Hall, Bruce L.
AU - Campbell, Darrell A.
AU - Phillips, Laurel R.S.
AU - Hamilton, Barton H.
N1 - Funding Information:
Dr Hall was also supported by the Center for Health Policy, under the auspices of Dr William Peck, Washington University in St Louis, St Louis, MO. This study was funded in part by Grant number 1U18HS11913-03 from the Agency for Healthcare Research and Quality.
PY - 2006/4
Y1 - 2006/4
N2 - BACKGROUND: There is increasing interest in evaluating quality in health care, extending to the assessment of outcomes, including costs, for individual surgeons. STUDY DESIGN: Surgical patients entered in the private sector National Surgical Quality Improvement Program at the University of Michigan Medical Center between September 2003 and September 2004 were included. Patient level characteristics and outcomes measures were combined with internal hospital cost data. Analysis was performed at the individual surgeon level using hospital costs as the outcomes variable, controlling for patient case-mix variables and procedural complexity. We used an econometric statistical model combining ordinary least squares and quantile regression methods, which allowed us to examine the effect of individual surgeons on costs. RESULTS: Considerable variation in costs across surgeons is demonstrated, holding patient case mix and procedural complexity constant. This is shown for mean estimates (p < 0.001) and estimates of 10th (p = 0.001), 50th (p < 0.001), and 90th (p = 0.013) percentiles. Examining the 10th to 90th interquantile range also demonstrates substantial variation in the ranges of costs for surgeons (p = 0.005), implying volatility in costs across providers, again holding patient case mix and procedural complexity constant. In dollar terms, 6 of 28 surgeons differ from a reference surgeon by 39% or more. CONCLUSIONS: Individual surgeons appear to have statistically and clinically significant differences in their costs and volatility of costs when holding patient factors and procedural complexity constant. Implications for quality improvement and incentive programs are discussed.
AB - BACKGROUND: There is increasing interest in evaluating quality in health care, extending to the assessment of outcomes, including costs, for individual surgeons. STUDY DESIGN: Surgical patients entered in the private sector National Surgical Quality Improvement Program at the University of Michigan Medical Center between September 2003 and September 2004 were included. Patient level characteristics and outcomes measures were combined with internal hospital cost data. Analysis was performed at the individual surgeon level using hospital costs as the outcomes variable, controlling for patient case-mix variables and procedural complexity. We used an econometric statistical model combining ordinary least squares and quantile regression methods, which allowed us to examine the effect of individual surgeons on costs. RESULTS: Considerable variation in costs across surgeons is demonstrated, holding patient case mix and procedural complexity constant. This is shown for mean estimates (p < 0.001) and estimates of 10th (p = 0.001), 50th (p < 0.001), and 90th (p = 0.013) percentiles. Examining the 10th to 90th interquantile range also demonstrates substantial variation in the ranges of costs for surgeons (p = 0.005), implying volatility in costs across providers, again holding patient case mix and procedural complexity constant. In dollar terms, 6 of 28 surgeons differ from a reference surgeon by 39% or more. CONCLUSIONS: Individual surgeons appear to have statistically and clinically significant differences in their costs and volatility of costs when holding patient factors and procedural complexity constant. Implications for quality improvement and incentive programs are discussed.
UR - http://www.scopus.com/inward/record.url?scp=33645286990&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2005.12.015
DO - 10.1016/j.jamcollsurg.2005.12.015
M3 - Article
C2 - 16571423
AN - SCOPUS:33645286990
SN - 1072-7515
VL - 202
SP - 565
EP - 576
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 4
ER -