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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 ($$).

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a national comparison of laparoscopic versus open colectomy using nsqip

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

slide2

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
defining value
Defining Value
  • Risk Adjusted Comparison
  • Outcomes defined
  • Resource Consumption
  • Transparency of Reporting
    • Hospital/Physician Comparison
    • Informed Consent
complex interactions quality
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
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

Sources of Surgical Cost
potential administrative data sources
Potential Administrative Data Sources
  • CMS
    • National Inpatient Census
  • Premier
  • ACS-NSQIP
  • Surgical Risk Formulae
what is nsqip
What is NSQIP
  • 30 day observational database
  • Trained and audited nurse evaluators
  • 121 sites in the US (academic and community hospitals)
nsqip lap v open
NSQIP Lap v Open

Kennedy et al. Ann Surg 2009;249: 596–601

nsqip lap v open1
NSQIP Lap v Open

Kennedy et al. Ann Surg 2009;249: 596–601

nsqip lap v open2
NSQIP Lap v Open

Kennedy et al. Ann Surg 2009;249: 596–601

nsqip lap v open3
NSQIP Lap v Open

Kennedy et al. Ann Surg 2009;249: 596–601

nsqip lap v open4
NSQIP Lap v Open

Kennedy et al. Ann Surg 2009;249: 596–601

nsqip lap v open outcomes
NSQIP Lap v Open: Outcomes

Senagore et al. DCR 2009 52: 183-6

nsqip lap v open cohorts
NSQIP Lap v Open: ? cohorts

Senagore et al. DCR 2009 52: 183-6

slide17

Departmental length of stay

1991-1999 1999 3-6/2000

n LOS n LOS n LOS

DRG 148

study team 1784 9.5 185 8.6 62 5.7 *

other CR teams 6459 9.8 824 8.8 162 10.1

Laparoscopic 24 3.2 *

DRG 149

study team 742 6.4 69 5.2 44 3.5 †

other CR teams 2256 6.4 327 5.1 111 4.5

Laparoscopic 18 2.5 *

DRG 148 & 149

study team 2526 8.6 254 7.7 106 4.7 §

other CR teams 8715 8.9 1151 7.7 273 7.7

Laparoscopic 42 2.9 *

* p<0.0001; † p=0.002; §p<0.001, Student’s t test

Delaney, Fazio, Senagore et al, Br J Surg, 2001

conclusion
Conclusion
  • Belief in a system approach
  • Align stakeholder incentives
  • Understanding Cost/Quality Impacts
  • Report OUR Value Proposition