Variation in Health Care Cost: Quality, Utilization, and Efficiency Review for ACL Surgery Cost Variance Within a Health Care System

OBJECTIVES: Variation in health care costs is an area of focus amongst national policy experts. While cost variation between facilities is an important area of investigation, cost variation within the same institution is recognized as an opportunity for rapid process change to provide better value to patients. The purpose of this study was to perform a Quality, Utilization, Efficiency (QUE) review for ACL surgery. METHODS: This project was reviewed by an IRB and approved for performance improvement. Using models developed by Intermountain Health Care, a QUE review was done for ACL procedures within a 22 surgeon, 7 hospital system. Cost data from January through June 2013 was reviewed. Four consistent cost categories were identified, and analyzed for cost variation among surgeons: tibial fixation, femoral fixation, graft choice, and tools/disposable instruments. RESULTS: The range in costs for these 4 categories to perform an ACL reconstruction ranged from $392.80 to $7,838.73, a difference of $7,445.93 and a mean of $2,128.93. Tibial fixation costs ranged from $42.43 to $580.00 (average $171.78). Femoral fixation ranged from $95.00 to $865.00 (average $287.33). The graft cost ranged from $1,275.00 to $2,545.75 (average $1,976.43). Suture prices for each individual suture, varied from $1.19 to $130.82, a range of $129.63 and mean $28.00. Tools and disposable supplies ranged from $184.00 to $896.00 (average of $346.00). CONCLUSION: The cost difference in ACL reconstructive surgeries showed a twenty-fold increase from minimum to maximum for different cost categories. In some cases, higher costs may be necessary for more complex and revision cases. As health systems and physicians collaborate to improve health care quality and value for patients, accurate information on cost will be important for providers. Rational variation in health care costs, which arise from patient-centered care, is appropriate. Irrational variations in care and procedural costs are not justified, and these variations offer opportunities to provide better care and value to patients. Providing high quality and timely information about costs is critical for engaging physicians in improving quality.