Department of Surgery, University of Kentucky, 800 Rose Street, Room MN274, Lexington, KY, 40536-0298, USA.
Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA.
Surg Endosc. 2019 Feb;33(2):494-498. doi: 10.1007/s00464-018-6323-9. Epub 2018 Jul 9.
The purpose of this study was to determine perioperative professional fee payments to providers from different specialties for the care of patients undergoing inpatient open ventral hernia repair (VHR).
Perioperative data of patients undergoing VHR at a single center over 3 years were selected from our NSQIP database. 180-day follow-up data were obtained via retrospective review of records and phone calls to patients. Professional fee payments (PFPs) to all providers were obtained from our physician billing system for the VHR hospitalization, the 180 days prior to operation (180Prior) and the 180 days post-discharge (180Post).
PFPs for 283 cases were analyzed. Average total 360-day PFPs per patient were $3409 ± SD 3294, with 14.5% ($493 ± 1546) for services in the 180Preop period, 72.5% ($2473 ± 1881) for the VHR hospitalization, and 13.0% ($443 ± 1097) in the 180Postop period. The surgical service received 62% of PFPs followed by anesthesia (18%), medical specialties (9%), radiology (6%), and all other provider services (5%). Medical specialties received increased PFPs for care of patients with COPD and HCT < 38% ($90 and $521, respectively) and for the pulmonary complications ($2471) and sepsis ($2714) that correlated with those patient comorbidities; surgeons did not. Operative duration, mesh size, and separation of components were associated with increased surgeon PFPs (p < .05). At 6 months, wound complications were associated with increased surgeon and radiology payments (p < .01).
Management of acute comorbid conditions and the associated higher postoperative morbidity is not reimbursed to the surgeon under the 90-day global fee. These represent opportunity costs of care that pressure busy surgeons to select against these patients or to delegate more management to their medical specialty colleagues, thereby increasing total system costs. A comorbid risk adjustment of procedural reimbursement is warranted. In negotiating bundled payments, surgeon groups should keep in mind that surgeon reimbursement, unlike medical specialty and hospital reimbursement, have been bundled since the 1990s.
本研究旨在确定不同专业的医疗从业者在为接受住院开放式腹疝修复（VHR）的患者提供护理方面的围手术期专业费用支付情况。
从我们的 NSQIP 数据库中选择了一家中心 3 年内接受 VHR 的患者的围手术期数据。通过对病历的回顾和对患者的电话随访，获得了 180 天的随访数据。从我们的医生计费系统中获得了 VHR 住院、手术前 180 天（180Preop）和出院后 180 天（180Post）期间所有提供者的专业费用支付（PFPs）。
对 283 例患者进行了分析。平均每位患者 360 天的总 PFP 为 3409 美元±SD3294，其中 14.5%（493 美元±1546）用于手术前 180 天的服务，72.5%（2473 美元±1881）用于 VHR 住院，13.0%（443 美元±1097）用于手术后 180 天。手术服务获得了 62%的 PFP，其次是麻醉科（18%）、内科（9%）、放射科（6%）和所有其他提供者服务（5%）。内科专业因 COPD 和 HCT<38%的患者的护理而获得了更多的 PFP（分别为 90 美元和 521 美元），以及与这些患者合并症相关的肺部并发症（2471 美元）和脓毒症（2714 美元）；外科医生没有。手术时间、网片大小和组件分离与外科医生 PFP 的增加有关（p<0.05）。术后 6 个月时，伤口并发症与外科医生和放射科医生的支付增加有关（p<0.01）。
在 90 天的全球费用下，急性合并症的管理和随之而来的更高的术后发病率没有向外科医生报销。这些代表了治疗的机会成本，迫使忙碌的外科医生选择这些患者或将更多的管理工作委托给他们的内科同事，从而增加了整个系统的成本。有必要对程序报销进行合并症风险调整。在协商捆绑支付时，外科医生团体应牢记，与医疗专业和医院报销不同，自 20 世纪 90 年代以来，外科医生的报销已经捆绑在一起。
