Z. Rashid1, E.B. Worku1, M. Khalil1, S. Woldesenbet1, T.M. Pawlik1 1Ohio State University Wexner Medical Center, Department Of Surgery, Columbus, OH, USA
Introduction:
Despite cost-standardization efforts, significant variations in hospital costs persist in insurance claims. We sought to identify and quantify the factors driving cost variability at both the hospital and cost center levels.
Methods:
Individuals who underwent pancreatectomy (PA), colectomy (CO), and proctectomy (PR) were identified from the Surveillance, Epidemiology, and End Results database. Index surgery costs across 1,262 hospitals were compared, adjusting for clinical, demographic, and geographic factors. Multilevel regression modeling was utilized to identify hospital, cost center, and patient level factors associated with variability in charges.
Results:
Among 35,908 individuals (PA: 8.2%; CO: 79.4%; PR: 12.4%) included in the analytic cohort, median age at the time of surgery was 78 years (IQR: 72 – 84) and more than one-half of patients were male (n=20,151, 56.1%). Median Medicare payments varied significantly by cancer type (CO: $21,704, PA: $26,709, PR: $21,228, p-value <0.001). Of note, operating room ($6,891, 23.82%), hospital stay ($5,931, 20.9%), and professional fees ($4,352, 15.35%) were the top cost centers, comprising 60% of total costs. A sub-analysis by the specialty of healthcare providers demonstrated that surgeons were responsible for the highest charges (PA: $2,037 [IQR: $740 – $2,831]; CO: $2,131 [IQR, $1,823 – $2,673]; PR: $2,243 [IQR: $1,876 – $2,969]) followed by anesthesiologists (PA: $622 [IQR, $454 – $797]; CO: $431 [IQR: $305 – $667]; PR: $480 [IQR: $305 – $722]). Charges associated with critical care specialists (PA: $873 [IQR: $99 – $1,914]; CO: $511 [IQR: $37 – $1,741]; PR: $269 [IQR: $36 – $1,129]) and pathologists (PA: $278 [IQR: $195 – $390]; CO: $250 [IQR: $180 – $376]; PR: $272 [IQR: $188 – $380]) were relatively low. On multilevel modeling, total charge variability was primarily influenced by patient factors (83%), followed by surgeon factors (9%) and hospital factors (8%) (Figure).
Conclusion:
There is significant variation in spending at the cost center level in the surgical treatment of gastrointestinal cancers. Patient factors demonstrated the greatest variability, followed by hospital and surgeon-level factors. Implementing value-based healthcare and standardized surgical protocols may improve both care quality and cost-effectiveness.