E. C. Hall1,2,3, A. Zeymo1, K. S. Chan1, W. Al-Refaie1,2 1MedStar-Georgetown Surgical Outcomes Research Center,Washington, DC, USA 2MedStar Georgetown University Hospital,Surgery,Washington, DC, USA 3MedStar Washington Hospital Center,Surgery,Washington, DC, USA
Introduction: Although equal access to quality surgical care has been a longstanding concern, there are no accepted measures of surgical access equity. Our aim is to validate Medicaid Emergency Room-Specialty Center Equivalence Ratio (MERSCER), an extension of our previously published work on surgical access equity, as such a measure.
Methods: Using the State Inpatient Databases (2012-2014) for a representative population of the United States, we identified high-volume hospitals (HVH) for three sets of complex, elective procedures: gastric, liver, and lung resections. We calculated each HVH’s MERSCER by comparing the ratio of the percentage of Medicaid patients that received complex elective surgery to the percentage of Medicaid patients that received emergent bowel surgery within the same center. MERSCER <1 indicates a center with disproportionately higher number of privately-insured patients relative to Medicaid patients undergoing complex elective procedures, and thus a proxy for access inequity. MERSCER was tested for significance using Mantel-Haenszel approach. Recursive partitioning was used to evaluate hospital and county level characteristics from the Area Resource File associated with lower MERSCER.
Results: 157 HVH were included. Pooled estimates for MERSCER were 0.62 (0.58-0.63) for gastric, 0.61 (0.56-0.67) for liver, and 0.75 (0.7-0.85) for lung resections. 82% of HVH-gastric, 76% of HVH-liver and 67% of HVH-lung had decreased equity (MERSCER <1). Hospitals with lower MERSCER values (decreased equity) were associated with higher proportions of elders, white patients, and patients from higher income areas.
Conclusion: For selected elective, complex procedures there were trends of inequity in surgical access across high-volume surgical centers, evidenced by disproportional numbers of privately-insured vs. Medicaid patients receiving complex elective surgery at high volume centers (MERSCER <1). The development of measures of equity is an important step to track and reward hospitals for providing equal access to all patients.
Figure 1: MERSCER Distribution Among High Volume Hospitals for Gastric Procedures. MERSCER <1 indicates disproportionately higher number of privately-insured patients undergoing complex elective procedures.
