B. T. Cain1, A. P. O’Rourke1, H. Jung1, A. E. Liepert1, S. K. Agarwal1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: Reimbursement for surgical care is based upon Current Procedural Terminology (CPT) codes for a ninety-day global period regardless of patient presentation: elective or acute. It is generally accepted that care for acutely ill patients is more involved than that of their less emergently presenting counterparts; however, the long term ramifications of timing of surgical intervention is not considered by payers or hospital systems. Our objective was to characterize the preoperative condition, cost, and complexity of care for elective versus urgent/emergent patients.
Methods: A retrospective chart review of patients who underwent colectomies at the University of Wisconsin Hospital and Clinics (UWHC) between February 2013 and February 2014 was performed. Patient comorbidities, insurance status, ASA score, and length of hospital stay (LOS) were recorded along with mortality, hospital readmissions, emergency room visits, physician charges, and negative postoperative events within a ninety-day postoperative period. Comparisons were made between patients undergoing elective procedures and those undergoing urgent/emergent operations.
Results: A total of 273 patients were included in this study. Of these, 183 underwent elective procedures while 90 required urgent/emergent operation. Emergent/urgent patients had a higher ASA score (2.73 vs. 2.17; p<0.001), longer LOS (12.66 days vs. 5.89 days; p<0.001), and greater number of negative postoperative events (4.79 vs. 1.63; p<0.001). Physician charges were found to be significantly less in urgent/emergent patients ($6865.00 vs. $7342.64; p<0.01), while no significant difference was observed in patient comorbidities between the two groups (Charlson comorbidity index score 4.26 vs. 4.47; p=0.554).
Conclusion: Emergent/urgent colectomy patients have a higher ASA score, a longer postoperative LOS, and experience more negative postoperative events. These patients require a greater investment of physician resources and time to optimally treat; however, physician charges associated with emergent/urgent colectomy patients are less. This disconnect between acute care surgeon effort and compensation may negatively impact the field’s ability to recruit the most competitive residents and ultimately provide the best possible patient care. Lobbying efforts aimed at rectifying the inequity in payment for amount of work performed should be initiated with the Center for Medicare and Medicaid Services, as well as with private insurers.
