For a study, the researchers sought to determine the sources of variation in 90-day episode spending in Health Care patients undergoing bariatric surgery and whether spending variation was related to treatment quality. Between January 1, 2011, and September 30, 2016, a retrospective examination of fee-for-service Medicare claims data from 761 acute care hospitals delivering inpatient bariatric surgery was conducted. Using multivariable regression models, investigators looked at the relationships between patient and hospital characteristics, clinical outcomes, and total Medicare spending for the 90-day bariatric surgery episode. About 46% of the 64,537 patients had a sleeve gastrectomy, 22% returned to the ED within 90 days, and 12.5% were readmitted. The average 90-day episode payment was $14,124, with the lowest quintile of hospitals spending $12,220 and the highest quintile spending $16,887. After risk adjustment, the lowest quintile spent $11,447 on a 90-day episode than the highest quintile’s $15,380 (difference $3932, P<0.001). Readmissions (44% of the variation, or $2043 per episode), post-acute care (19%, or $871), and professional index fees (15%, or $450) were the most significant components of cost variation. Complication, ED visit, post-acute utilization, and readmission rates were also lowest in the lowest-spending institutions (P<0.001). Readmissions, inpatient professional fees, and post-acute care consumption were the most significant 90-day episode cost variation components in this retrospective analysis of Medicare patients undergoing bariatric surgery. Complications, ED visits, post-acute utilization, and readmissions were lower in hospitals with lower spending. In Medicare’s bundled payment approach for bariatric surgery, incentives for improving outcomes and minimizing spending appear to be well-aligned.
