To help rein in surgical spending, there is growing interest in the application of payment bundles to common outpatient procedures like ureteroscopy (URS) and shockwave lithotripsy (SWL). However, before urologists can move to such a payment system, they need to know where their episode costs are concentrated.
Using claims data from the Michigan Value Collaborative, we identified patients who underwent URS or SWL at hospitals in Michigan (2012 to 2015). We then totaled expenditures for all relevant services during these patients' 30-day surgical episodes and categorized component payments [i.e., those for the index procedure, subsequent hospitalizations, professional services, and post-acute care (PAC)]. Finally, we quantified variation in total episode expenditures for URS and SWL across hospitals, examining drivers of this variation.
In total, 9,449 URS and 6,446 SWL procedures were performed at 62 hospitals. Among these hospitals, there was three-fold variation in URS and SWL spending. The index procedure accounted for the largest payment difference between high- and low-cost hospitals (URS: $7,936 vs. $4,995, P<0.01; SWL: $4,832 vs. $3,207, P<0.01), followed by payments for PAC (URS: $2,207 vs. $1,711, P<0.01; SWL: $2,138 vs. $1,104, P<0.01). The index procedure explained 68% and 44%, and PAC payments explained 15% and 28% of the variation in episode spending for URS and SWL, respectively, across hospitals.
There exists substantial variation in ambulatory surgical spending across Michigan hospitals for urinary stone episodes, most of which can be explained by payment differences for the index procedure and PAC services.
The Journal of urology. 2017 Nov 24 [Epub ahead of print]
Juan San Juan, Hechuan Hou, Khurshid R Ghani, James M Dupree, John M Hollingsworth
Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan., Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: .