Daniel L Davenport, PHD1, Margaret Plymale, DNP, RN2, Ray Mirembo, BA3, Travis Hughes, MD2, John S Roth, MD2. 1University of Kentucky, Department of Surgery, 2University of Kentucky, Division of General Surgery, 3University of Kentucky, College of Medicine
Introduction: The purpose of this study was to determine professional fee payments by specialty for the care of patients undergoing open ventral hernia repair.
Methods and Procedures: A retrospective review of patients undergoing open ventral hernia repairs (OVHR) at an academic medical center between October, 2011 and September, 2014. Perioperative data were selected from our NSQIP database. Follow up for wound occurrences, readmissions and other major morbidity was extended to 180 days via review of the clinic record and phone calls to the patient. Professional fee payments (PFPs) to all providers were obtained from our physician billing system for the OVHR hospitalization (OVHR), for 180 days prior (180Prior), and for 180 days post-discharge (180Post) and summed to 360d PFPs.
Results: A total of 301 OVHRs were analyzed. Patients had mean age of 52 years; 56% were female; 18% were morbidly obese; and 60% were ASA class III or IV. Thirteen percent were emergent cases and 81% of wounds were clean. Mean 360d PFPs were $3,320 ± SD 3,239, comprised of: 180Prior, 15.1% ($501 ± 1,539); OVHR, 71.8% ($2,383 ± 1,865); and 180Post, 13.1% ($436 ± 1,071). The surgical service received 62% of 360d PFPs followed by anesthesia at 18%, medical specialties at 9%, radiology 6% and all others 5%. Patient age and creatinine levels correlated with medical specialty PFPs (rho = .30 and .15 resp., p’s < .05) but not with surgeon PFPs. None of the other demographic or clinical risk factors available in NSQIP data correlated with surgeon or any specialty’s PFPs, including ASA class, obesity, COPD, diabetes, and preoperative open wound. Operative factors such as emergent status, operative duration, and separation of components increased surgeon PFPs (all p < .05). Major 30-day complications such as sepsis and pneumonia increased medical specialty ($2,800 and $2,600 resp., p's < .001) and radiology PFPs ($400 for sepsis, p < .01) but not surgeon PFPs. At 6 months, wound complications were associated with increased surgeon ($500, p < .05) and radiology payments ($400,p < .01).
Conclusions: Management of acute comorbid conditions and the associated higher early morbidity is unreimbursed to the surgeon, potentially pressuring busy surgeons to select against these patients. In negotiating bundled payments, surgeon groups should keep in mind that surgeon reimbursement, unlike medical and hospital reimbursement, has been bundled since the 90’s with no comorbid adjustment, and vigorously defend what is an already disproportionately reduced share of reimbursement.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86573
Program Number: P049
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster