Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI.
Ann Surg. 2020 Jan;271(1):23-28. doi: 10.1097/SLA.0000000000003165.
Surgical care has been largely untargeted by Medicare payment reforms because episode costs associated with its delivery are not currently well understood.
To quantify the costs of inpatient and outpatient surgery in the Medicare population.
We analyzed claims data from a 20% national sample of Medicare beneficiaries (2008-2014). For a given study year, we identified all inpatient and outpatient procedures and constructed claims windows around them to define surgical episodes. After summing payments for services rendered during each episode, we totaled all inpatient and outpatient episode payments by surgical specialty. For inpatient episodes, we determined component payments related to the index hospitalization, readmissions, physician services, and postacute care. For outpatient episodes, we differentiated by the site of care (hospital outpatient department versus physician office versus ambulatory surgery center). We used linear regression to evaluate temporal trends in inpatient and outpatient surgical spending. Finally, we estimated the contribution of surgical care to overall Medicare expenditures.
Total Medicare payments for surgical care are substantial, representing 51% of Program spending in 2014. They declined modestly over the study period, from $133.1 billion in 2008 to $124.9 billion in 2014 (-6.2%, P = 0.085 for the temporal trend). While spending on inpatient surgery contributed the most to total surgical payments (69.4% in 2014), it declined over the study period, driven by decreases in index hospitalization (-16.7%, P = 0.002) and readmissions payments (-27.0%, P = 0.003). In contrast, spending on outpatient surgery increased by $8.5 billion (28.7%, P < 0.001). This increase was realized across all sites of care (hospital outpatient department: 36.6%, P < 0.001; physician office: 22.1%, P < 0.001; ambulatory surgery center: 36.6%, P < 0.001). Ophthalmology and hand surgery witnessed the greatest growth in surgical spending over the study period.
Surgical care accounts for half of all Medicare spending. Our findings not only highlight the magnitude of spending on surgery, but also the areas of greatest growth, which could be targeted by future payment reforms.
医疗保险支付改革在很大程度上没有针对外科护理，因为目前还不完全了解其提供服务的相关项目成本。
量化医疗保险人群中住院和门诊手术的成本。
我们分析了 2008 年至 2014 年全国 Medicare 受益人的 20%的抽样数据。对于给定的研究年度，我们确定了所有的住院和门诊手术，并围绕这些手术构建了索赔窗口以定义手术期。在汇总每次手术期间提供的服务付款后，我们按外科专业汇总所有住院和门诊手术期付款。对于住院手术期，我们确定了与索引住院、再入院、医生服务和康复后护理相关的分项付款。对于门诊手术期，我们根据护理地点（医院门诊部门、医生办公室、门诊手术中心）进行了区分。我们使用线性回归来评估住院和门诊手术支出的时间趋势。最后，我们估计了外科护理对医疗保险总支出的贡献。
医疗保险外科护理的总支出非常可观，占 2014 年项目支出的 51%。在研究期间，这一支出呈适度下降趋势，从 2008 年的 1331 亿美元降至 2014 年的 1249 亿美元（下降 6.2%，P = 0.085 表示时间趋势）。虽然住院手术支出对总手术支出的贡献最大（2014 年为 69.4%），但由于索引住院（-16.7%，P = 0.002）和再入院支出（-27.0%，P = 0.003）的减少，这一支出在研究期间有所下降。相比之下，门诊手术支出增加了 85 亿美元（28.7%，P < 0.001）。这一增长发生在所有护理地点（医院门诊部门：36.6%，P < 0.001；医生办公室：22.1%，P < 0.001；门诊手术中心：36.6%，P < 0.001）。眼科和手部手术是研究期间手术支出增长最快的领域。
外科护理占医疗保险支出的一半。我们的研究结果不仅突出了手术支出的规模，还突出了增长最快的领域，这些领域可能成为未来支付改革的目标。
