What Are the Most Significant Cost and Value Drivers for Pancreatic Resection in an Integrated Healthcare System?

Publication Title

Journal of the American College of Surgeons

Authors

Brooke Vuong, John Wayne Cancer Institute at Providence Saint John's Hospital, Santa Monica, CAFollow
Ahmed N Dehal, John Wayne Cancer Institute at Providence St John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USAFollow
Abhineet Uppal, John Wayne Cancer Institute at Providence Saint John's Hospital, Santa Monica, CAFollow
Stacey L Stern, John Wayne Cancer Institute at Providence Saint John's Hospital, Santa Monica, CAFollow
Juan Mejia, Providence Sacred Heart Medical Center, Spokane, WA.Follow
Roshanthi Weerasinghe, Providence St Joseph Health, Renton, WA.Follow
Vandana Kapoor, Providence St Joseph Health, Renton, WA.Follow
Evan Ong, Swedish Medical Center, Seattle, WA.Follow
Paul D Hansen, Providence Portland Medical Center, Portland, OR.Follow
Anton J Bilchik, John Wayne Cancer Institute at Providence Saint John's Hospital, Santa Monica, CAFollow

Document Type

Article

Publication Date

7-1-2018

Abstract

BACKGROUND: An initiative was established to improve value-based care for pancreatic surgery in a large nonprofit health system. Cost data were presented bimonthly to a hepatobiliary clinical performance group via videoconference.

STUDY DESIGN: The direct costs were calculated for all patients undergoing distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) between January 2014 and July 2017. Median length of stay, 30-day and 90-day mortality rates, readmission rate, and costs were stratified by surgeon volume using 2 published criteria: "volume pledge" criteria (≥5 PDs/year) and Leapfrog criteria (≥11 PDs/year).

RESULTS: There were 270 DPs and 526 PDs performed in 14 hospitals spanning 4 states. Median PD costs were lower for high-volume surgeons (≥5 PDs/year), $21,026 vs $24,706 (p = 0.005). High-volume surgeons had a shorter length of stay (9 days vs 11 days; p < 0.001) for PD and DP (6 days vs 7 days; p = 0.001). Increased costs for low-volume surgeons included operative/anesthesia costs ($7,321 vs $6,325; p = 0.03), room and board ($5,828 vs $4,580; p = 0.01), and intensive care costs ($4,464 vs $3,113; p = 0.04). Operating time was increased for high-volume surgeons for DP and PD (p < 0.001). There was no difference in 30-day or 90-day mortality rates or readmissions for DP or PD when stratified by volume pledge criteria. There was no difference in total costs for DP or PD when stratified by Leapfrog criteria.

CONCLUSIONS: There was a significant cost reduction for PD but not DP when the threshold of 5 PDs was used as a definition of high volume. The sharing of detailed financial data with HPB surgeons on a regular basis provides an opportunity to evaluate practice patterns and thereby reduce direct costs.

Clinical Institute

Cancer

Clinical Institute

Digestive Health

Specialty/Research Institute

Oncology

Specialty/Research Institute

Gastroenterology

Specialty/Research Institute

Surgery