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How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy

BACKGROUND AND OBJECTIVES: Maricopa Medical Center (MMC) was found to have higher charges and length-of-stays than 16 other regional hospitals in an analysis of DRG categories for gallbladder disease. These comparative figures identified MMC as being inefficient and demanded review to determine the...

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Autores principales: Weiland, Dennis Edward, Caruso, Daniel Martin, Wesche, Daniel Eric, Bay, Ralph Curtis
Formato: Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 1997
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016738/
https://www.ncbi.nlm.nih.gov/pubmed/9876690
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author Weiland, Dennis Edward
Caruso, Daniel Martin
Wesche, Daniel Eric
Bay, Ralph Curtis
author_facet Weiland, Dennis Edward
Caruso, Daniel Martin
Wesche, Daniel Eric
Bay, Ralph Curtis
author_sort Weiland, Dennis Edward
collection PubMed
description BACKGROUND AND OBJECTIVES: Maricopa Medical Center (MMC) was found to have higher charges and length-of-stays than 16 other regional hospitals in an analysis of DRG categories for gallbladder disease. These comparative figures identified MMC as being inefficient and demanded review to determine the reasons for the inefficiencies. METHODS: In an attempt to determine the reason for inefficiency of charges and length-of-stay for the laparoscopic portion of laparoscopic cholecystectomy, matched pairs of open cholecystectomy and converted laparoscopic cholecystectomy from a data base of 633 patients with cholecystectomies were reviewed. Thirty-five matches for age, sex and similar diagnosis were successful. RESULTS: Matched pair evaluation disclosed a $6,880 difference in charges, which was attributed solely to the charge for laparoscopy. Subsequent chart analysis showed a high charge for instrumentation, prolonged anesthesia and operative times and longer preoperative delays before surgery. Moreover, no matter what the conversion rate is, open cholecystectomy was more cost effective. However, if there is a conversion rate of 5%, total hospital charges for laparoscopic cholecystectomy would have to be reduced to $12,679 (a reduction of $3,332 from $16,011) to make laparoscopic cholecystectomy cost-effective. CONCLUSIONS: Cost-effective decision tree analysis of matched pair comparisons and sensitivity analysis proves to be an effective technique in evaluating the cost-effectiveness of laparoscopic cholecystectomy in a hospital population.
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spelling pubmed-30167382011-02-17 How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy Weiland, Dennis Edward Caruso, Daniel Martin Wesche, Daniel Eric Bay, Ralph Curtis JSLS Commentary BACKGROUND AND OBJECTIVES: Maricopa Medical Center (MMC) was found to have higher charges and length-of-stays than 16 other regional hospitals in an analysis of DRG categories for gallbladder disease. These comparative figures identified MMC as being inefficient and demanded review to determine the reasons for the inefficiencies. METHODS: In an attempt to determine the reason for inefficiency of charges and length-of-stay for the laparoscopic portion of laparoscopic cholecystectomy, matched pairs of open cholecystectomy and converted laparoscopic cholecystectomy from a data base of 633 patients with cholecystectomies were reviewed. Thirty-five matches for age, sex and similar diagnosis were successful. RESULTS: Matched pair evaluation disclosed a $6,880 difference in charges, which was attributed solely to the charge for laparoscopy. Subsequent chart analysis showed a high charge for instrumentation, prolonged anesthesia and operative times and longer preoperative delays before surgery. Moreover, no matter what the conversion rate is, open cholecystectomy was more cost effective. However, if there is a conversion rate of 5%, total hospital charges for laparoscopic cholecystectomy would have to be reduced to $12,679 (a reduction of $3,332 from $16,011) to make laparoscopic cholecystectomy cost-effective. CONCLUSIONS: Cost-effective decision tree analysis of matched pair comparisons and sensitivity analysis proves to be an effective technique in evaluating the cost-effectiveness of laparoscopic cholecystectomy in a hospital population. Society of Laparoendoscopic Surgeons 1997 /pmc/articles/PMC3016738/ /pubmed/9876690 Text en © 1997 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Commentary
Weiland, Dennis Edward
Caruso, Daniel Martin
Wesche, Daniel Eric
Bay, Ralph Curtis
How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy
title How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy
title_full How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy
title_fullStr How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy
title_full_unstemmed How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy
title_short How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy
title_sort how managed care may choose hospitals for contracts for laparoscopic cholecystectomy
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016738/
https://www.ncbi.nlm.nih.gov/pubmed/9876690
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