H. L. Hill1, T. R. Grenda1,2, J. R. Thumma2, J. B. Dimick1,2, C. P. Scally1,2 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Center For Healthcare Outcomes And Policy,Ann Arbor, MI, USA
Introduction: Concerns have been raised regarding the effect of market influences on the adoption of new surgical procedures. In an effort to identify non-clinical factors driving utilization of laparoscopic colectomy, we evaluated the impact of hospital market competition on utilization, focusing on low volume providers where premature adoption may threaten patient outcomes.
Methods: We used Medicare claims data (2009-2012) to identify patients undergoing elective colectomy for cancer resection (laparoscopic n = 60,261, open n = 104,386). Patients were assigned to Core Based Statistical Areas (CBSA) in which they were treated, each CBSA representing a market area. Competition by CBSA was quantified using an econometric measure of market saturation, the Hirschman-Herfindahl index (HHI). CBSAs were stratified into HHI tertiles and the proportion of laparoscopic colectomies performed was evaluated across tertiles. We further stratified the cohort by surgeon volume to specifically analyze the impact of inter-hospital competition on low volume providers.
Results: A total of 36% (n = 164,647) of colon resections from 2009 to 2012 were performed laparoscopically. We identified no trend toward increasing utilization across tertiles of increasing competition with 33% of colon resections performed laparoscopically in high competition settings compared to 36% in mid-competition settings and 31% in low-competition settings. Moreover, our findings identified no association between increasing hospital competition and adoption by low volume surgeons. The proportion of laparoscopic procedures performed within the low volume group was similar across competition levels at 15%, 18% and 18% respectively for markets of high-, mid- and low-competition.
Conclusion: These findings indicate that utilization of a laparoscopic approach for colon cancer resection was not highly sensitive to market pressures. Furthermore, market forces did not affect colectomy procedure choice in low volume settings.