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Referring high-risk surgeries
to high-volume hospitals may save lives but not money
Policies aimed at referring patients who need high-risk procedures
such as coronary artery bypass graft (CABG) surgery to hospitals that
conduct a high volume of such surgeries could save thousands of lives
each year, according to some estimates. However, this approach may
not necessarily reduce direct health care costs, finds a study led
by John Birkmeyer, M.D., of Dartmouth-Hitchcock Medical Center. The
research was supported in part by the Agency for Healthcare Research
and Quality
.
Dr. Birkmeyer and his colleagues examined the economic impact of
regionalization from the hospital, payer, and societal perspectives.
From the hospital perspective, this strategy will primarily redistribute
surgical profits from smaller to bigger medical centers. Using data
from a cross-section of New England hospitals, they estimated average
hospital profits for four surgical procedures. Based on average hospital
profits for CABG, a hospital giving up 100 procedures a year to a
higher volume hospital would experience a net financial loss of $684,000.
From the payer perspective, prices paid for procedures will likely
increase in some geographic areas, according to Dr. Birkmeyer, as
a result of decreased competition among providers.
From society's perspective, it is uncertain how volume-based referral
policies would affect the true cost of providing surgical care. Concentrating
selected procedures in a smaller number of high-volume centers could
create some financial efficiencies as well as savings associated with
better quality of care.
However, there would also be new costs. Increasing procedure volume
at high-volume centers would require adding capacity (operating rooms
and beds) at some facilities. There would be new administrative costs
associated with transferring medical information between referring
and referral hospitals. Finally, volume-based referral strategies
would concentrate more care at teaching hospitals, where care tends
to be more expensive compared with smaller non teaching hospitals.
Surgical costs could also increase to the extent that volume-based
referral policies create incentives for hospitals to do more procedures.
The risk that such policies could increase the use of surgery is highest
with procedures performed for discretionary clinical conditions, notes
Dr. Birkmeyer. For example, there is a considerable gray area as surgeons
decide which patients should undergo CABG for lifestyle-limiting coronary
artery disease.
For more details, see "Will volume-based referral strategies
reduce costs or just save lives?" by Dr. Birkmeyer, Jonathan
Skinner, Ph.D., and David Wennberg, M.D., M.P.H., published in Health
Affairs.
One
of the most common types of hospital operating rooom surgeries performed
in the United States each year is the removal of cataracts. This is partly
due to the fact that so many people develop this condition. In fact, over
half of the population aged 60 and older (approximately 60%) have cataracts;
by age 75, over 70% of Americans have cataracts. Fortunately, cataract
surgery is one of the safest and most effective operations performed today.
Since August is Cataract Awareness Month, and because most of us are likely
to be affected by cataracts at some point in our lives, this is an optimal
time to become more familiar with this condition. 
Heart
Surgery is performed every day in the USA. This is another very common
surgery performed every day is coronary bypass or valve repair and replacement
surgeries. And even though there is a shortage of donor organs, about
2,000 people had heart transplants. 