R. Xie1, B. Lindeman1, H. Chen1, T. N. Wang1 1University Of Alabama at Birmingham,Surgery,Birmingham, Alabama, USA
Introduction: Increasing health care costs in the U.S. have not translated to superior outcomes in comparison to other developed countries. The implementation of physician-directed intervention to reduce cost may improve value-driven health outcomes. This study aimed to evaluate the effectiveness of cost-targeted interventions to reduce surgical expense and improve care for patients undergoing total thyroidectomies.
Methods: Two separate face-to-face interventions with individual surgeons focusing on surgical expense around thyroidectomy were implemented in two surgical services (Endocrine Surgery and Otolaryngology) at a tertiary medical center. The pre-intervention period was from Dec 2014 to Jun 2016 (19 months, 352 operations). The post-intervention period was from July 2016 to January 2018 (19 months, 360 operations). Multivariable generalized linear regression analyses and difference-in-difference analyses were conducted to compare the pre- and post-intervention outcomes including cost outcomes (total costs, fixed costs, and variable costs per thyroidectomy) and clinical outcomes (30-day readmission rate, days to readmission, and total length of stay).
Results: Patient demographics and characteristics were similar before and after the interventions. Post-intervention operative costs were significantly reduced as compared to pre-intervention costs. The percentage savings in the average total, fixed, and variable costs per surgery were 8% (from $6,571 to $6,033, p=0.03), 7% (from $4,062 to $3,781, p=0.04), and 10% (from $2,509 to $2,251, p=0.03), respectively. Additionally, the clinical outcome parameter of total length of stay improved from 1.3 days (STD: 1.9) to 1.0 day (STD: 0.2, p<0.01). Readmission rates and days to readmission were not significantly different. The effectiveness of the interventions regarding cost reductions differed between the two surgical divisions. Compared to Otolaryngology, Endocrine Surgery saved an additional average total cost of $517.30 (STD: 877.7; p=0.08), average fixed cost of $238.40 (STD: 526.9; p=0.18), and average variable cost of $279.00 (STD: 423.2; p=0.05) per surgery since the intervention.
Conclusion: Targeted-physician interventions can be an effective tool for reducing cost and improving health outcomes. The effectiveness of interventions may vary depending on the type of specialty training. Future implementation of physician interventions needs to be standardized in order to critically evaluate its effectiveness on patient outcomes.