Department of Surgery, The University of Vermont Larner College of Medicine, Burlington, Vermont; Department of Surgery, The University of Vermont Medical Center, Burlington, Vermont.
Department of Surgery, The University of Vermont Medical Center, Burlington, Vermont.
J Surg Educ. 2019 May-Jun;76(3):802-807. doi: 10.1016/j.jsurg.2018.11.001. Epub 2018 Nov 25.
Surgical care contributes significantly to the fiscal challenges facing the US health care system. Multiple studies have demonstrated surgeons' lack of awareness of the costs associated with individual portions of surgical care, namely operating room supplies. We sought to assess surgeon and trainee awareness of the comprehensive charges and reimbursements associated with procedures they perform.
We administered a voluntary anonymous survey to attending surgeons, general surgery residents, and fourth-year medical students who applied to general surgery residencies. We compared charge and reimbursement estimates for laparoscopic cholecystectomy and open inguinal hernia repair to the actual values. Additionally, we assessed the importance placed on the financial aspects of surgical care.
We had an overall response rate of 94% (n = 45). A majority of attendings, residents, and medical students underestimated charges and reimbursements for open inguinal hernia repair and laparoscopic cholecystectomy. There was no significant difference in the accuracy of charge or reimbursement estimates between attendings, residents, and students for herniorrhaphy or cholecystectomy (Charge: hernia p = 0.08, cholecystectomy p = 0.30; Reimbursement: hernia p = 0.47, cholecystectomy p = 0.89). Years of training as an attending or resident did not predict accuracy of charge or reimbursement estimates for hernia repair or cholecystectomy (p > 0.3 for all regressions). The median (interquartile range) charge estimate for inguinal hernia repair was -$5914 (-$7914 to -$2914) from the actual charge, 45.8% of the true value, and the median reimbursement estimate was -$4519 (-$5369 to -$1218) from actual reimbursement, 27.3% of the true value. The median charge estimate for cholecystectomy was -$5734 (-$8733 to +$1266) from the actual charge, 58.3% of the true value, and the median reimbursement estimate was -$4847 (-$6847 to +$153) from actual reimbursement, 38.2% of the true value.
Surgeons and their trainees underestimate the charges and reimbursements associated with commonly performed procedures.
外科护理是美国医疗保健系统面临的财政挑战的重要组成部分。多项研究表明，外科医生对与外科护理各个部分相关的成本缺乏认识，即手术室用品。我们试图评估外科医生和住院医师对他们执行的手术程序的综合费用和报销的认识。
我们向主治外科医生、普通外科住院医师和申请普通外科住院医师的四年级医学生发放了一份自愿匿名调查。我们将腹腔镜胆囊切除术和开放式腹股沟疝修补术的费用和报销估计值与实际值进行了比较。此外，我们评估了外科护理财务方面的重要性。
我们的总体回复率为 94%（n=45）。大多数主治医生、住院医师和医学生低估了开放式腹股沟疝修补术和腹腔镜胆囊切除术的费用和报销。在疝修补术或胆囊切除术的费用或报销估计值的准确性方面，主治医生、住院医师和学生之间没有显著差异（费用：疝 p=0.08，胆囊切除术 p=0.30；报销：疝 p=0.47，胆囊切除术 p=0.89）。作为主治医生或住院医师的培训年限并不能预测疝修补术或胆囊切除术费用或报销估计值的准确性（所有回归 p > 0.3）。腹股沟疝修补术的费用中位数（四分位距）估计值为-5914 美元（实际费用的-7914 美元至-2914 美元），占真实值的 45.8%，报销中位数估计值为-4519 美元（实际报销的-5369 美元至-1218 美元），占真实值的 27.3%。胆囊切除术的费用中位数估计值为-5734 美元（实际费用的-8733 美元至+1266 美元），占真实值的 58.3%，报销中位数估计值为-4847 美元（实际报销的-6847 美元至+153 美元），占真实值的 38.2%。
外科医生及其住院医师低估了常见手术的费用和报销。
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