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OPERATING ROOMS: How much major surgery is infrequent? Is there an impact on costs?

Texas hospitals were studied to see how many inpatient major surgical procedures were not performed very often (once a month or less) at each hospital analyzed.  In this study of discharge data from 343 hospitals for the period late 2015 to early 2016, over half (54 percent)  of procedures were found to be uncommon (as defined above) for the hospital where they were performed.  These procedures accounted for 68 percent of inpatient costs.

Source: O’Neill, L. and others. (2017, September). Discharges with surgical procedures performed less often than once a month per hospital account for two-thirds of hospital costs of inpatient surgery. Journal of Clinical Anesthesia. 41, 99-103. Click here for publisher’s website: http://www.jcafulltextonline.com/article/S0952-8180(17)30659-1/fulltext   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TRENDS: Outpatient utilization metrics have been going up

Health, United States, 2015 is available.  This is the latest in an annual compendium of statistics published by the federal government which is drawn from both government and nongovernment sources, including the American Hospital Association.  It’s a good place to start to look for historical trend statistics (usually at the national level) on topics related to health status and health care delivery.

Below are data from one table in this massive report.  The data below are authoritative national estimates, based on a sample survey, that were produced by the National Center for Health Statistics.

Why are utilization metrics expressed as “per 100 persons” or “per 1000 persons” interesting?  Because if you a health planner, you can take a geographical service area with a known population size and calculate the approximate number of physician office visits or hospital outpatient visits or emergency department visits that can be expected from that population in a twelve month period.  Doing a demand analysis would then go on to take into account the local competition and other factors, but national utilization estimates like this can be a helpful way to start.

PHYSICIAN OFFICE VISITS per 100 persons per year (age adjusted)

  • 271  1995
  • 304  2000
  • 325  2010
  • [not available] 2011

Note that this is consistently about 3 physician office visits per person per year.  Does that seem intuitively pleasing to you?  Did you go to see doctors three times last year?  Remember, too, that the above includes children and seniors.

HOSPITAL OUTPATIENT DEPARTMENT VISITS per 100 persons per year (age adjusted)

  • 26  1995
  • 31  2000
  • 33  2010
  • 40  2011

HOSPITAL EMERGENCY DEPARTMENT VISITS per 100 persons per year (age adjusted)

  • 37  1995
  • 40  2000
  • 43  2010
  • 45  2011

Source: Table 82, Visits to physician offices, hospital outpatient departments, and hospital emergency departments, by age, sex, and race: United States, selected years 1995-2011.  In U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. (2015). Health, United States, 2015. Retrieved from http://www.cdc.gov/nchs/hus.htm  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MODELS: Regionalization of hospitals and ambulatory care facilities [illustration]

This is an illustration of three different models which might be used to coordinate the bricks-and-mortar facilities within a health care system.  The three types of regionalization illustrated include:

  • Hub-and-spoke model — in which there is a big central hospital that serves as a referral center for smaller hospitals with limited services.  The outpatient centers as well as the smaller hospitals feed in to the big central hospital.
  • Distributed model — in which each of the hospitals is a center of excellence in a different service line, such as cardiology
  • Coordinated model — in which service lines are coordinated among the hospitals and performance is measured at the system level

These models, particularly the hub-and-spokes model of regionalization, are not necessarily new concepts, but I like the way that they are compared in this drawing.

Source: Fink, J. (2014, Nov.) Aligning with physicians to regionalize services. HFM. Healthcare Financial Management, 68(11), 80-86. Retrieved from https://www.hfma.org/Content.aspx?id=25739  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Developing regional centers of excellence can be challenging

One of the trends in surgery over the past few decades has been the development of less invasive alternatives to open surgical procedures of many different types.  This short commentary, out of Temple University School of Medicine in Philadelphia, takes a look at one such procedure–transcatheter aortic valve replacement (TAVR).  Because valve replacement surgery candidates are often elderly and have other medical problems besides the malfunctioning valve, there has been considerable interest in offering a less invasive alternative.  However, it has been found that there is a higher risk of stroke for patients who have undergone TAVR compared with the open procedure.

There is an extensive literature available on the relationship between volume and outcome — generally finding that greater experience (doing more procedures) is associated with better patient outcomes.  This supports the notion that it might be a good idea to develop regional centers of excellence, so that patient volume could be concentrated in a few specialized programs instead of being spread out in smaller numbers at various hospitals in the area.  The authors note that in their market — the Philadelphia metro area — regionalization has NOT occurred, and suggest a few of the reasons why not.

Source: Feldman, A.M., and DiSesa, V.J.  Transcather aortic valve replacement: flattening the cost curve.  JAMA, May 5, 2014.  Full text free here: http://jama.jamanetwork.comarticle.aspx?articleid=1868540    Posted by AHA Resource Center (312) 422-2050, rc@aha.org