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85 - 05-23
Surgeon Variation in Surgical Case Costs

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SURGEON VARIATION IN SURGICAL CASE COSTS
LINDSAY HAMPSON, ANOBEL ODISHO, MAXWELL MENG, PETER CARROLL

Introduction
•Analysis of practice variation can provide insight into the efficient delivery of high-value surgical care
•Providing high-value care requires balancing costs and quality
•Assessment of variation in OR supply utilization can help elucidate the surgeon- and systems-specific factors that contribute to cost and quality

Methods

Cases

•Elective urologic surgical procedures performed at UCSF Medical Center over a 1 year period (9/2012 – 9/2013)
•Evaluated the top ten most common procedures in which at least two surgeons had performed the procedure at least twice
•Any cases consisting of multiple billed procedures were excluded given that costs were pooled in these cases
•Surgeons de-identified

 

Costs

•Supplies: institutional-negotiated rate, reflecting amount paid by UCSF for each item (NOT reimbursement)
•Operative time monetized assuming $69/minute

 

Statistical Analysis

•Mean case supply cost and case duration cost by surgeon were analyzed with one-way ANOVA
•Analysis of factors associated with case supply cost above the mean for each procedure was conducted using multilevel mixed effects logistic regression clustered by surgeon
 
Results

TABLE 1: PROCEDURE COST VARIATION AMONG SURGEONS

10 Most Frequent Procedures Performed by at Least Two Surgeons

 

TABLE 2: CASE & COST DATA

 

FIGURE 1: LAP RADICAL NEPHRECTOMY SUPPLY COST PER CASE BY SURGEON

 

FIGURE 2: VISUAL REPRESENTATION OF MULTIVARIATE LOGISTIC REGRESSION - PREDICTORS OF SUPPLY COST ABOVE MEAN

 

Discussion

Potential Interventions

•Surgeon feedback: anonymized surgeon case-specific feedback to try to change behavior
•Provide supply-level cost and usage data
•Standardize supplies: stock lower-cost alternatives for expensive supplies
•Decrease overall costs
•Increase OR efficiency

Benefits of Approach

•Provides data on relative cost of supply and time cost
•Reflects real-world materials usage & cost-level data
•Identifies procedures and surgeon- and case-related factors that can be targeted for evaluation

Limitations

•Cost not linked to patient-related predisposing factors
•Cost not linked to patient outcome data
•Lack of variation does not negate opportunity for cost-savings

Future Directions

•Incorporate predisposing factors and functional outcomes
•Evaluate for change in case cost after surgeon feedback
 
Conclusions
 

There are significant variations in procedural costs among providers even within the same institution. Though supply costs constitute a fraction of overall surgical costs, targeting high-volume procedures with supply cost variability among providers for standardization could have a substantial impact on overall costs. Higher annual volume and more years of experience since training appear to be correlated with higher case supply costs.