医疗保险报销变化对膀胱癌门诊和住院内镜手术实践的影响。

The effect of changes in Medicare reimbursement on the practice of office and hospital-based endoscopic surgery for bladder cancer.

机构信息

Department of Urology, New York University Langone Medical Center, New York, NY, USA.

出版信息

Cancer. 2010 Mar 1;116(5):1264-71. doi: 10.1002/cncr.24875.

DOI:10.1002/cncr.24875

PMID:20143327

Abstract

BACKGROUND

Procedures performed in the office offer potential cost savings. Recent analyses suggest, however, that a fee-for-service system may incentivize subscale operations and, thus, contribute to excessive spending. The authors of this report sought to characterize changes in the practice of office-based and hospital-based endoscopic bladder surgery after 2005 increases in Medicare reimbursement.

METHODS

All office and hospital-based endoscopic surgeries that were performed in a faculty practice from 2002 through 2007 were identified using billing codes for procedures, diagnoses, and procedure locations and then analyzed using the chi-square test and logistic regression. Costs were estimated based on published Medicare reimbursements for office and hospital-based surgeries.

RESULTS

In total, 1341 endoscopic bladder surgeries were performed, including 764 in the office and 577 in the hospital. After 2005, the odds ratio (OR) for office surgery occurring among all cystoscopies and for surgery occurring in the office versus the hospital was 2.01 (95% confidence interval [CI], 1.71-2.37) and 2.29 (95% CI, 1.83-2.87), respectively. Among all treated lesions that were associated with a diagnosis of bladder cancer and nonbladder cancer, the OR for a procedure occurring in the office versus the hospital was 1.36 (95% CI, 1.07-1.73) and 1.99 (95% CI, 1.52-2.60), respectively. The likelihood of repeat surgery on the same lesion increased after 2005 (OR, 2.86; 95% CI, 1.46-5.62), and the likelihood of an office surgery leading to a bladder cancer diagnosis at the next visit declined (OR, 0.29; 95% CI, 0.16-0.51). The overall estimated expenditure increased by 50%.

CONCLUSIONS

After 2005, more bladder lesions were identified and treated in the office. In a single group practice, office treatment of bladder cancer did not fully explain this new practice pattern, suggesting a lowered threshold for office intervention.

摘要

背景

在诊所进行的手术具有降低成本的潜力。然而，最近的分析表明，按项目收费的制度可能会刺激低规模的手术，从而导致过度支出。本报告的作者试图描述在 2005 年 Medicare 报销增加后，诊所和医院内镜膀胱手术的实践变化。

方法

使用手术、诊断和手术地点的计费代码，从 2002 年至 2007 年确定了在教员实践中进行的所有诊所和医院内镜手术，然后使用卡方检验和逻辑回归进行分析。根据发表的 Medicare 对诊所和医院手术的报销费用来估算成本。

结果

共进行了 1341 例内镜膀胱手术，其中 764 例在诊所进行，577 例在医院进行。2005 年后，所有膀胱镜检查中进行诊所手术的几率比（OR）和在诊所进行手术的几率比（OR）分别为 2.01（95%置信区间[CI]，1.71-2.37）和 2.29（95% CI，1.83-2.87）。在与膀胱癌和非膀胱癌诊断相关的所有治疗病变中，在诊所进行手术的几率比（OR）和在医院进行手术的几率比（OR）分别为 1.36（95% CI，1.07-1.73）和 1.99（95% CI，1.52-2.60）。2005 年后，同一病变再次手术的可能性增加（OR，2.86；95% CI，1.46-5.62），而在下次就诊时，诊所手术导致膀胱癌诊断的可能性降低（OR，0.29；95% CI，0.16-0.51）。总支出估计增加了 50%。