Robinson Eric, Trivedi Parth, Neifert Sean, Eromosele Omeko, Liu Benjamin Y, Housman Brian, Ilonen Ilkka, Taioli Emanuela, Flores Raja
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY.
Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
JTCVS Open. 2023 May 9;14:538-545. doi: 10.1016/j.xjon.2023.04.020. eCollection 2023 Jun.
The objective of this study was to assess procedure markup (charge-to-cost ratio) across lung resection procedures and examine variability by geographic region.
Provider-level data for common lung resection operations was obtained from the 2015 to 2020 Medicare Provider Utilization and Payment Data datasets using Healthcare Common Procedure Coding System codes. Procedures studied included wedge resection; video-assisted thoracoscopic surgery; and open lobectomy, segmentectomy, and mediastinal and regional lymphadenectomy. Procedure markup ratio and coefficient of variation (CoV) was assessed and compared across procedure, region, and provider. The CoV, a measure of dispersion defined as the ratio of the SD to the mean, was likewise compared across procedure and region.
Median markup ratio across all procedures was 3.56 (interquartile range, 2.87-4.59) with right skew (mean, 4.13). Median markup ratio was 3.59 for lymphadenectomy (CoV, 0.51), 3.13 for open lobectomy (CoV, 0.45), 3.55 for video-assisted thoracoscopic surgery lobectomy (CoV, 0.59), 3.77 for segmentectomy (CoV, 0.74), and 3.80 for wedge resection (CoV, 0.67). Increased beneficiaries, services, and Healthcare Common Procedure Coding System score (total) were associated with a decreased markup ratio ( < .0001). Markup ratio was highest in the Northeast at 4.14 (interquartile range, 3.09-5.56) and lowest in the South (Markup ratio 3.26; interquartile range, 2.68-4.02).
We observe geographic variation in surgical billing for thoracic surgery.
本研究的目的是评估肺切除手术的费用加成（收费与成本之比），并考察不同地理区域的差异。
使用医疗保健通用程序编码系统代码，从2015年至2020年医疗保险提供者利用和支付数据集中获取常见肺切除手术的提供者层面数据。研究的手术包括楔形切除术；电视辅助胸腔镜手术；以及开放性肺叶切除术、肺段切除术、纵隔和区域淋巴结清扫术。评估并比较了不同手术、地区和提供者的费用加成率和变异系数（CoV）。变异系数是一种离散度指标，定义为标准差与均值之比，同样也在不同手术和地区之间进行了比较。
所有手术的中位费用加成率为3.56（四分位间距，2.87 - 4.59），呈右偏态（均值，4.13）。淋巴结清扫术的中位费用加成率为3.59（CoV，0.51），开放性肺叶切除术为3.13（CoV，0.45），电视辅助胸腔镜手术肺叶切除术为3.55（CoV，0.59），肺段切除术为3.77（CoV，0.74），楔形切除术为3.80（CoV，0.67）。受益人数增加、服务量增加以及医疗保健通用程序编码系统总分增加与费用加成率降低相关（P <.0001）。费用加成率在东北部最高，为4.14（四分位间距，3.09 - 5.56），在南部最低（费用加成率3.26；四分位间距，2.68 - 4.02）。
我们观察到胸外科手术计费存在地理差异。
