Targeting Value-Driven Quality Improvement for Laparoscopic Cholecystectomy in Michigan

Area of Science:

• Health Economics
• Surgical Quality Improvement
• Value-Based Healthcare

Background:

• Current value-based healthcare efforts primarily target high-risk inpatient surgeries.
• Laparoscopic cholecystectomy, a common, lower-risk procedure, presents an opportunity for quality improvement initiatives.

Purpose of the Study:

• To evaluate complete episode expenditures for laparoscopic cholecystectomy.
• To identify targets for value-based quality improvement in surgical care.

Main Methods:

• Analysis of 19,213 elective laparoscopic cholecystectomy cases from 2012-2015 using Medicare and private payer data.
• Calculation of price-standardized payments for the entire surgical episode.
• Risk- and reliability-adjusted linear regression analysis of expenditures based on patient characteristics, diagnoses, and additional procedures.

Main Results:

• Total episode costs varied 2.4-fold across surgeons ($7,922-$17,500).
• Higher expenditures were associated with increased complication rates (10% vs. 5%), readmissions (14% vs. 8%), and lower rates of ambulatory procedures (77% vs. 56%).
• A 10% increase in ambulatory operations could yield $3.6 million in annual savings.

Conclusions:

• Significant variation exists in laparoscopic cholecystectomy episode payments across surgeons.
• Expanding ambulatory surgical practices offers substantial potential for beneficiary savings.
• Targeting ambulatory care expansion can drive value-based improvements in surgical spending.