Gani Faiz, Makary Martin A, Pawlik Timothy M
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Surgery, Wexner Medical Center at the Ohio State University, Columbus, Ohio.
J Surg Res. 2017 Feb;208:192-197. doi: 10.1016/j.jss.2016.09.032. Epub 2016 Sep 28.
Despite cost containment efforts, the price for surgery is not subject to any regulations. We sought to characterize and compare variability in pricing for commonly performed major surgical procedures across the United States.
Medicare claims corresponding to eight major surgical procedures (aortic aneurysm repair, aortic valvuloplasty, carotid endartectomy, coronary artery bypass grafting, esophagectomy, pancreatectomy, liver resection, and colectomy) were identified using the Medicare Provider Utilization and Payment Data Physician and Other Supplier Public Use File for 2013. For each procedure, total charges, Medicare-allowable costs, and total payments were recorded. A procedure-specific markup ratio (MR; ratio of total charges to Medicare-allowable costs) was calculated and compared between procedures and across states. Variation in MR was compared using a coefficient of variation (CoV).
Among all providers, the median MR was 3.5 (interquartile range: 3.1-4.0). MR was noted to vary by procedure; ranging from 3.0 following colectomy to 6.0 following carotid endartectomy (P < 0.001). MR also varied for the same procedure; varying the least after liver resection (CoV = 0.24), while coronary artery bypass grafting pricing demonstrated the greatest variation in MR (CoV = 0.53). Compared with the national average, MR varied by 36% between states ranging from 1.8 to 13.0. Variation in MR was also noted within the same state varying by 15% within the state of Arkansas (CoV = 0.15) compared with 51% within the state of Wisconsin (CoV = 0.51).
Significant variation was noted for the price of surgery by procedure as well as between and within different geographical regions. Greater scrutiny and transparency in the price of surgery is required to promote cost containment.
尽管采取了成本控制措施，但手术价格不受任何监管。我们试图描述和比较美国常见的主要外科手术定价的差异。
使用2013年医疗保险提供者利用和支付数据医生及其他供应商公共使用文件，识别与八种主要外科手术（主动脉瘤修复、主动脉瓣成形术、颈动脉内膜切除术、冠状动脉搭桥术、食管切除术、胰腺切除术、肝切除术和结肠切除术）相对应的医疗保险索赔。对于每种手术，记录总费用、医疗保险允许成本和总支付额。计算特定手术的加价率（MR；总费用与医疗保险允许成本的比率），并在不同手术和不同州之间进行比较。使用变异系数（CoV）比较MR的差异。
在所有提供者中，MR的中位数为3.5（四分位间距：3.1 - 4.0）。注意到MR因手术而异；从结肠切除术后的3.0到颈动脉内膜切除术后的6.0（P < 0.001）。同一手术的MR也有所不同；肝切除术后变化最小（CoV = 0.24），而冠状动脉搭桥术的定价在MR方面变化最大（CoV = 0.53）。与全国平均水平相比，各州之间的MR差异为36%，范围从1.8到13.0。在同一州内也注意到MR的差异，阿肯色州内差异为15%（CoV = 0.15），而威斯康星州内差异为51%（CoV = 0.51）。
手术价格在不同手术之间以及不同地理区域之间和区域内均存在显著差异。需要对手术价格进行更严格的审查和提高透明度，以促进成本控制。
