Each year in the United States, more than 50,000 Medicare patients die undergoing inpatient surgery. Evidence of wide variations across providers suggests substantial room for improvement. To improve surgical care in the elderly, the Center for Medicare and Medicaid Services (CMS) has launched several policies. However, the extent to which these policies improve outcomes and reduce costs in surgery is unknown. We therefore propose a systematic evaluation of the impact of several policy options on the quality and cost of surgical care in the national Medicare population. With this goal in mind, our current proposal has the following aims:
Aim 1. To evaluate the impact of CMS improvement policies on surgical outcomes. We will conduct evaluations of pay-for-performance, selective referral, bundled payment, and outcomes feedback in the national Medicare population. For each policy approach, we will take advantage of a natural experiment (i.e., a specific program or policy implemented in the last 5 years). To assess outcomes, we will use risk-adjusted mortality and complications for the procedures specifically targeted by the policy. To better control for hospital case-mix and secular trends, we will use a difference-in-difference methodology.
Aim 2. To evaluate the spillover effects of these CMS policies on untargeted surgical conditions. Using national Medicare data, we will examine outcomes for untargeted procedures for which patients receive care from the same surgeons or depend on the same hospital resources. We will assess whether these policies resulted in beneficial spillover effects or caused unintended harm as resources were diverted to the targeted conditions.
Aim 3. To evaluate the impact of these policies on Medicare payments around the surgical episode. We will evaluate Medicare payments for the full range of services that can be linked to complications and poor quality care. We will include payments to the hospital, physicians, readmissions, and post-acute care. The results of this study will facilitate evidence-based policymaking by CMS and other payers. As effective policies for improving care are implemented, surgical patients will be the ultimate beneficiaries of this research.

Public Health Relevance

This study will have immediate real-world impact for CMS policymakers and surgical patients. The results of this proposal will provide CMS with data on the comparative effectiveness of various initiatives for improving quality and decreasing costs. As effective strategies for improving care are implemented by CMS and other payers, surgical patients will be the ultimate beneficiaries of this research.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG039434-04
Application #
8658363
Study Section
Special Emphasis Panel (ZRG1-HDM-R (02))
Program Officer
Baker, Colin S
Project Start
2011-04-15
Project End
2015-03-31
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
4
Fiscal Year
2014
Total Cost
$318,775
Indirect Cost
$113,775
Name
University of Michigan Ann Arbor
Department
Surgery
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Scally, Christopher P; Shih, Terry; Thumma, Jyothi R et al. (2016) Impact of a National Bariatric Surgery Center of Excellence Program on Medicare Expenditures. J Gastrointest Surg 20:708-14
Ibrahim, Andrew M; Hughes, Tyler G; Thumma, Jyothi R et al. (2016) Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries. JAMA 315:2095-103
Reames, Bradley N; Scally, Christopher P; Frankel, Timothy L et al. (2016) National trends in resection of cystic lesions of the pancreas. HPB (Oxford) 18:375-82
Scally, Christopher P; Thumma, Jyothi R; Birkmeyer, John D et al. (2015) Impact of Surgical Quality Improvement on Payments in Medicare Patients. Ann Surg 262:249-52
Scally, Christopher P; Ryan, Andrew M; Thumma, Jyothi R et al. (2015) Early impact of the 2011 ACGME duty hour regulations on surgical outcomes. Surgery 158:1453-61
Varban, Oliver A; Reames, Bradley N; Finks, Jonathan F et al. (2015) Hospital volume and outcomes for laparoscopic gastric bypass and adjustable gastric banding in the modern era. Surg Obes Relat Dis 11:343-9
Gonzalez, Andrew A; Abdelsattar, Zaid M; Dimick, Justin B et al. (2015) Time-to-readmission and Mortality After High-risk Surgery. Ann Surg 262:53-9
Ryan, Andrew M; Burgess Jr, James F; Dimick, Justin B (2015) Why We Should Not Be Indifferent to Specification Choices for Difference-in-Differences. Health Serv Res 50:1211-35
Osborne, Nicholas H; Nicholas, Lauren H; Ryan, Andrew M et al. (2015) Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA 313:496-504
Sjoding, Michael W; Iwashyna, Theodore J; Dimick, Justin B et al. (2015) Gaming hospital-level pneumonia 30-day mortality and readmission measures by legitimate changes to diagnostic coding. Crit Care Med 43:989-95

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