• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Variation in national DRG payments for laparoscopic cholecystectomy: Hospital level analysis

Pushwaz Virk, MD, Charudutt Paranjape, MD. Akron General Medical Center, Akron, OH.

Introduction: In 2013, Centers for Medicare and Medicaid Services (CMS) released data about Diagnosis Related Group (DRG) payments made to over 3000 acute care hospitals in 2011. The data included the average amount billed to CMS by each hospital for top 100 DRGs, as well as average amount paid to the hospital those DRGs in one year. DRG system is a fixed reimbursement to hospitals for Medicare patients based on diagnosis, procedures, age and expected length of stay. Each DRG is further classified into three severity types – With Major Complications or Comorbidities, With Complications or Comorbidities and Without Complications or Comorbidities. The payment rate is determined by multiple factors including local wage index. Laparoscopic cholecystectomy (LapChole) is one of the most common and established surgical procedures. We analyzed LapChole DRG data to assess the variability of Medicare payments across all hospitals in US.

Methods: We identified hospitals which had billed for more than 10 discharges in a year for two commonest LapChole DRGs – Laparoscopic Cholecystectomy without Common Duct Exploration with Complications or Comorbidities (DRG 418) and without Complications or Comorbidities (DRG 419). There were a total of 18,227 discharges in DRG 418 and 16,157 in DRG 419. The dollar amounts were rounded.

Results: For DRG 418, 959 acute care hospitals were included. National average of charges submitted to CMS by hospitals was $48,091 and average payment made to hospitals was $11,518. Highest average charge was submitted by Crozer Chester Medical Center, Upland, PA of $173,772. Lowest average charge was $11,689 submitted by Anne Arundel Medical Center, Annapolis, MD. Highest average payment by CMS per discharge was $25,205 made to UCSF Medical center, San Francisco, CA and lowest payment was $8,117 to Thomas Hospital, Fairhope, AL. For DRG 419, 871 hospitals were included. National average payment was $8,068 against the average submitted charge of $34,724. St Mary & Elizabeth Medical Center, Chicago, IL received the highest payment of $16,207 and lowest payment was to Thomas Hospital, Fairhope, AL of $5,710. Highest average charge submitted was $140,449 by Northbay Medical Center, Fairfield, CA. The lowest average charge was $6,750 by Gallup Indian Medical Center, Gallup, NM. Florida Hospital, Orlando, FL had the highest number of discharges in either category. There was a variation of over 1400% in the submitted charge for the same DRG severity type and over 300% in payments made. There was no significant difference in payments based on the hospital ownership type. However, the submitted charges by hospitals were significantly higher by proprietary hospitals compared to government owned or non-profit hospitals for both DRGs.

Conclusion: The analysis enables surgery programs to compare and benchmark against their peers regionally or nationally. The information is also beneficial to patients who have to pay out of pocket for this surgery. DRG system does not reward efficiencies nor incorporates surgical outcomes, so with emerging healthcare environment focusing on cost control and improving efficiencies, newer payment methods may need to be instituted.

View Poster

2,035

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2014 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons