A study analyzing variation in spending for patients undergoing ureteroscopy (URS) or shock wave lithotripsy (SWL) for urinary stone disease is a step towards helping urologists understand cost reduction opportunities as they face the possibility of payment bundling for these outpatient procedures, according to researchers from the University of Michigan, Ann Arbor.
Using claims data from the Michigan Value Collaborative, the investigators tabulated expenditures from the date of surgery to 30 days after discharge related to the index procedure, subsequent hospitalizations, professional services, and post-acute care. Then, they examined variation between hospitals in total episode and component expenditures and analyzed which factors were driving the variation. The dataset represented 9,449 URS procedures and 6,446 SWL procedures performed at 62 hospitals in Michigan between 2012 and 2015. The findings were presented at the World Congress of Endourology and SWL in Vancouver, Canada.
The investigators found substantial variation in ambulatory surgical spending for urinary stone episodes across the Michigan hospitals, with a three-fold difference in mean total spending comparing the hospitals with the lowest and highest total per episode expenditure for either URS or SWL. With the hospitals grouped into four equal-sized quartiles based on total spending, most of the variation between the lowest and highest cost providers was explained by differences for the index procedure and post-acute care services.
“Taken together, these findings suggest that efforts to decrease provider variation in spending for the index procedure and post-acute care are likely to go a long way towards reducing the costs associated with surgical care for urinary stone disease. The findings from our study can also be used by policymakers involved in the design and implementation of payment bundles that aim to rein in spending for urinary stone strategy,” said senior author John M. Hollingsworth, MD.
Across all hospitals, mean total episode expenditure was $11,054 for URS and $7,668 for SWL. Looking at expenditures for each of the four components contributing to the total showed that hospitals in the highest quartile for total spending for SWL also had received significantly higher payments for the index procedure, professional services, subsequent hospitalization, and post-acute care compared with hospitals in the lowest spending quartile. For URS, payments for all components except subsequent hospitalization were significantly higher at the highest quartile hospitals compared with the lowest quartile hospitals.