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Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures
Adam R Roumm1, Laura Pizzi, Neil I Goldfarb
1Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA.
Abstract:
It is generally believed that minimally invasive surgery (MIS) results in less postoperative pain, fewer complications, and shorter recovery periods compared with open procedures. Yet despite these benefits, the level of reimbursement assigned to the surgeon by United States health-care payers is often lower than that for open procedures. Furthermore, the cost of performing a MIS may be higher vs an open procedure because specialized equipment, increased surgical time, or both may be required. In this report, we examine the issue by comparing reimbursements for MIS with open procedures, summarizing the medical literature on MIS vs open surgical procedures, and offering recommendations for payers who establish reimbursement policies. The review is focused on six MIS procedures where outcomes data exist: laparoscopic cholecystectomy (lap chole), laparoscopic colectomy (LC), laparoscopic fundoplication (LF), laparoscopic hysterectomy (LH), laparoscopic ventral hernia repair (LVHR), and laparoscopic appendectomy (LA). Outcomes summarized were length of hospital stay (LOS), operating room time, operating room costs, complications, and return to work or normal activities. The level of scientific evidence was assigned to each study using predetermined criteria. A total of 112 articles were reviewed: 14 for lap chole, 26 for LC, 7 for LF, 19 for LH, 9 for LVHR, and 37 for LA. The data demonstrate that these procedures result in reduced hospital stay, reduced hospital costs, and faster return to work or normal activities. Yet, the operating room time and costs are frequently higher for MIS. These findings suggest that as both the outcomes value and level of operating room resources are greater, MIS warrants reimbursement that meets or exceeds that of open procedures.
Insights
Minimally invasive surgery (MIS) offers better patient outcomes, including shorter hospital stays and faster recovery. Despite these benefits, MIS often receives lower reimbursement than open surgery, warranting a review of current payment policies.
Area of Science:
- Surgical Innovation
- Health Economics
- Comparative Effectiveness Research
Background:
- Minimally invasive surgery (MIS) is widely believed to offer advantages over open procedures, including reduced postoperative pain, fewer complications, and shorter recovery times.
- However, healthcare payers in the United States often provide lower reimbursement for MIS compared to open surgery.
- The direct costs of performing MIS can be higher due to specialized equipment and potentially longer operating room times.
Purpose of the Study:
- To compare reimbursement levels for MIS versus open surgical procedures.
- To summarize the existing medical literature on the outcomes of MIS compared to open surgery.
- To provide recommendations for healthcare payers regarding reimbursement policies for MIS.
Main Methods:
- A comprehensive review of 112 articles was conducted, focusing on six specific MIS procedures: laparoscopic cholecystectomy, colectomy, fundoplication, hysterectomy, ventral hernia repair, and appendectomy.
- Studies were evaluated based on predetermined criteria to assign a level of scientific evidence.
- Key outcomes analyzed included length of hospital stay, operating room time and costs, complication rates, and time to return to work or normal activities.
Main Results:
- Data from the reviewed studies consistently demonstrate that MIS leads to reduced hospital stays, lower hospital costs, and a faster return to work or normal activities.
- Operating room time and associated costs are frequently higher for MIS procedures compared to open surgery.
- Despite increased operating room resource utilization, the overall value and patient outcomes associated with MIS are superior.
Conclusions:
- Minimally invasive surgery provides significant benefits in terms of patient recovery and overall healthcare costs.
- The higher operating room resource utilization for MIS is offset by improved patient outcomes and reduced downstream costs.
- Reimbursement policies for MIS should be revised to reflect the demonstrated value and superior outcomes compared to open procedures, ideally meeting or exceeding current reimbursement for open surgery.
