Variation in value among hospitals performing complex cancer operations

Area of Science:

• Oncology
• Health Services Research
• Surgical Outcomes

Background:

• Variation in outcomes has driven centralization of complex cancer surgery.
• Variation in cost and value for these procedures remains largely unexplored.

Purpose of the Study:

• To evaluate outcomes relative to cost among hospitals performing esophageal and pancreatic resection for cancer.
• To identify highest-value hospitals based on cost and outcomes.

Main Methods:

• Utilized Medicare claims data (2014-2016) for elective esophagectomy and pancreatectomy.
• Calculated risk- and reliability-adjusted payments and complication rates per hospital.
• Categorized hospitals into quintiles based on payments and outcomes.

Main Results:

• Among 11,586 patients, 31.1% received care at high-value hospitals.
• Highest-value hospitals had significantly lower complication rates for pancreatectomy (22.7% vs 31.4%) and esophagectomy (29.8% vs 48.3%).
• Episode costs were lower at highest-value hospitals, with average differences of $5,617 for esophagectomy and $2,748 for pancreatectomy.

Conclusions:

• Significant variation exists in complication rates and costs between lowest- and highest-value hospitals for these complex cancer surgeries.
• Even high-quality hospitals show considerable variation in average episode costs.
• Surgeons must understand and address practice variation to standardize care, improve outcomes, and reduce costs.