A New Perspective on the Value of Minimally Invasive Colorectal Surgery- Payer, Provider, and Patient Benefits

Deborah S Keller, MS, MD1, Kate Fitch, RN, MEd2, Andrew Bochner, BA2, Eric M Haas, MD, FACS, FASCRS3. 1Colorectal Surgical Associates, 2Milliman, 3Colorectal Surgical Associates; Houston Methodist Hospital; University of Texas Medical Center at Houston

Background: While the clinical benefits of minimally invasive surgery (MIS) have been proven over open surgery, the overall financial benefits are yet to be fully explored.  Our goal was to evaluate the financial benefits of MIS from the payer’s perspective to demonstrate the value of minimally invasive colorectal surgery. The reduction in cost, complications, and readmissions with MIS could result in an overall benefit to the healthcare system.

Methods: A claim-based analysis using commercial Truven MarketScan® data identified all 2013 elective, non-metastatic, inpatient colectomy cases. Member eligibility was required in all months of 2012 and ≥1 month of 2013. Cases were stratified into open or MIS approaches based on ICD-9 procedure codes: Open; 45.71-45.76. 45.79, 45.82, 45.83 MIS; 17.31-17.36, 17.31, 45.81. Care episodes (colectomy inpatient stay and 30 days post discharge) were compared for average allowed costs (amount paid to providers by the payer plus member cost sharing) and readmission rates after adjusting for demographics, comorbidities, geographic region, and malignant diagnosis. 

Results: 4,615 elective, non metastatic inpatient colectomies were identified – 2,054 (44.5%) open and 2,561 (55.5%) MIS. Total allowed episode costs for MIS colectomy were significantly lower than open colectomy ($37,540 vs. $45,284, p<0.001). During the inpatient colectomy stay, open cases had greater ICU utilization (3.9% open vs. 2.0% MIS, p<.001) and a significantly longer LOS than MIS (6.39 vs. 4.44 days, p<.001). The MIS cohort had significantly lower average allowed costs for the inpatient colectomy stay ($33,183 MIS vs. $39,585 open, p<0.001).  Post discharge, open cases had significantly higher readmission rates per 100 cases (11.54 vs. 8.28; p=0.0013), higher average readmission costs ($3,055 vs. $2,514; p=0.1858), and greater 30-day healthcare costs than MIS ($5,699, vs. $4,377; p=0.0033). The overall cost savings between MIS and open surgery were $7,744 per patient.

Conclusions: In a commercially insured population undergoing elective colectomy for non-metastatic cases, the risk adjusted allowed costs for MIS colectomy episodes were significantly lower than open.  The overall cost difference between MIS and open surgery was almost $8,000 per patient. These results highlight an opportunity for health plans and employers to realize benefits by shifting from open to MIS for colectomy. With the increasing number of health systems participating in bundled payment arrangements and accountable care shared savings programs, the potential from cost shifting to MIS will become even more important.

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