Preoperative Care Intensity and Cost for Renal Colic: Implications for Surgical Value-Based Reforms

Area of Science:

• Health Economics
• Surgical Outcomes
• Healthcare Policy

Background:

• Value-based payment models are increasingly important in healthcare.
• Renal colic surgery provides a model to study cost drivers.
• Identifying factors influencing costs can optimize payment strategies.

Purpose of the Study:

• To identify patient and facility factors linked to preoperative, postoperative, and total episode costs for renal colic surgery.
• To inform the design of value-based payment models by understanding cost associations.
• To analyze cost variations in surgical management of renal colic.

Main Methods:

• Retrospective cohort study using state Healthcare Cost and Utilization Project data.
• Analysis of perioperative costs for patients undergoing surgical management for renal colic.
• Multivariable logistic regressions to assess associations between cost quartiles and patient/hospital factors.

Main Results:

• Episode-related costs varied widely, from $4536 to $26,662.
• Higher preoperative costs were associated with a significantly higher probability of increased postoperative costs (11.7%).
• Surgical delays and Medicaid insurance were linked to higher preoperative costs.

Conclusions:

• Preoperative costs are a significant predictor of both postoperative and total episode costs in renal colic surgery.
• These findings underscore the need to incorporate preoperative cost factors into value-based payment models.
• Optimizing preoperative management and addressing insurance disparities may reduce overall healthcare expenditures.