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A National Comparison of Laparoscopic versus Open Colectomy Using NSQIP. Anthony J Senagore M.D, M.S., M.B.A. VP/CAO, Spectrum Health Professor of Surgery, Michigan State University Grand Rapids, MI. Anxiety About Health Care ($$). - PowerPoint PPT Presentation
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Spectrum Health
1
A National Comparison of Laparoscopic versus Open Colectomy Using NSQIP
Anthony J Senagore M.D, M.S., M.B.A.VP/CAO, Spectrum Health
Professor of Surgery, Michigan State UniversityGrand Rapids, MI
Spectrum Health
Anxiety About Health Care ($$)
Employers: premiums growing at 2-3x wages; affecting profits and competitiveness
Consumers: higher out-of-pocket costs keeping real wage growth down; fear of losing insurance; lack of information for confident decisions
Insurers: pressure from employer customers to control rising costs
Doctors and Hospitals: Medicare reimbursement rates; administrative challenges of data collection, performance measurement and reporting
Spectrum Health
Defining Value
Risk Adjusted Comparison Outcomes defined Resource Consumption Transparency of Reporting
Hospital/Physician Comparison Informed Consent
Spectrum Health
Complex Interactions:Quality
Hospital Systems Diagnostic Equipment/access Staffing OR equipment
Operative Technique Postoperative Care
Preoperative Evaluation/Optimization Enhanced Recovery Protocols Post-Discharge care plans
Spectrum Health
Sources of Surgical Cost
Hospital Issues Beds Personnel OR’s Diagnostic
equipment
Doctor Issues # admissions/ LOS Complications Case volume/mix Duration of Surgery Equipment used Tests ordered Readmissions
Spectrum Health
Potential Administrative Data Sources
CMS National Inpatient Census
Premier ACS-NSQIP Surgical Risk Formulae
Spectrum Health
What is NSQIP
30 day observational database Trained and audited nurse evaluators 121 sites in the US (academic and
community hospitals)
Spectrum Health
Departmental length of stay1991-19991991-1999 19991999 3-6/2000 3-6/2000
nn LOSLOS nn LOSLOS nn LOSLOS
DRG 148DRG 148study team study team 17841784 9.59.5 185185 8.68.6 6262 5.7 *5.7 *other CR teamsother CR teams 64596459 9.89.8 824824 8.88.8 162162 10.110.1LaparoscopicLaparoscopic 2424 3.2 *3.2 *
DRG 149DRG 149study teamstudy team 742742 6.46.4 6969 5.25.2 4444 3.5 †3.5 †other CR teamsother CR teams 22562256 6.46.4 327327 5.15.1 111111 4.54.5LaparoscopicLaparoscopic 1818 2.5 *2.5 *
DRG 148 & 149DRG 148 & 149study teamstudy team 25262526 8.68.6 254254 7.77.7 106106 4.7 4.7 §§other CR teamsother CR teams 87158715 8.98.9 11511151 7.77.7 273273 7.77.7LaparoscopicLaparoscopic 4242 2.92.9 **
* * pp<0.0001; † <0.0001; † pp=0.002; =0.002; §§ pp<0.001, Student’s t test<0.001, Student’s t test
Delaney, Fazio, Senagore et al, Br J Surg, 2001