A financial analysis of payment per unit time for common general surgery operations
1
distribution”. Nearly twenty years later, the answer to whether socio- economic status impacts outcomes remains unresolved. METHODS: Prospective data collected on bariatric surgical patients at 555 facilities participating in the American Society for Metabolic and Bariatric Surgery Bariatric Surgery Center of Excellence (BSCOE) program were collected between June 2007 and Septem- ber 2009. 65,410 patients met inclusion criteria. Of these, 8,537 patients had insurance provided by Centers of Medicare and Medic- aid Services (CMS); 7,090 with Medicare and 1,808 with Medicaid insurance. Demographic, clinical, perioperative and postoperative data were compared between patients with CMS insurance (CMS) and those whose surgery was covered by other insurers (non-CMS). RESULTS: CMS patients differ sharply from those covered by pri- vate insurance in terms of mean age (years) (53.0 vs 44.3; p.0001) preoperative medications (6.80 vs. 3.35; p0001); percent of pa- tients without postoperative medications (11.9% vs 31.3%: p.0001); 90-day serious complications (2.28% vs. 0.93%; p.0001) and 90-day mortality (0.26 vs 0.09; p.0001). CONCLUSIONS: Patients insured by Medicare and Medicaid un- dergoing bariatric surgery present with a higher risk profile and suffer worse postoperative outcomes compared to those covered by private carriers. While the CMS patients may have the most to gain from the surgery, they also bring higher risks. A financial analysis of payment per unit time for common general surgery operations Abhishek Chatterjee MD, MBA, Stefan D Holubar MD, Lilian Chen MD, Shirley A Montagne MBA, Joseph M Rosen MD, Joseph P Desimone MD Dartmouth Hitchcock Medical Center, Lebanon, NH INTRODUCTION: A payment per unit time model incorporates a surgeons reimbursement to the total care time spent in the operating room, post operative in-house and post operative clinic visit period. Our goal is to analyze and compare common outpatient operations to common inpatient operations in general surgery by using the payment per unit time method. METHODS: Surgeon payments per case were recorded over the 2009 financial year for 5 common outpatient and 4 common in- patient general surgery operations at our tertiary care health center. Total care time (TCT) was defined as the sum of the times spent by the surgeon with the patient in the operating room in addition to 30 minutes per day in the hospital and per office visit. We calculated the payment per unit time by dividing the physician reimbursement per case by the total care time for each surgical case. RESULTS: The average payment per time spent for inpatient oper- ations was $455.73 and slightly more at $467.51 for outpatient procedures. Partial colectomy with primary anastomosis had the least payment per time spent ($188.52)and laparoscopic gastric bypass had the highest ($707.30). CONCLUSIONS: The payment per time method shows a similar reimbursement process for common outpatient and inpatient gen- eral surgery cases performed at a tertiary care health center. However, partial colectomy surgery, while requiring the most total care time, has substantially less payment per time spent compared to other cases. What is the significance of circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy? AtthaphornTrakarnsanga MD, Mithat Gonen PhD, Jinru Shia MD, Philip B Paty MD, FACS, José G Guillem MD, FACS, FASCRS, Larissa K FTemple MD, FACS, FRCSC, Garrett M Nash MD, MPH, FACS, Karyn A Goodman MD, MS, Martin R Weiser MD, FACS Memorial Sloan-Kettering Cancer Center, New York, NY INTRODUCTION: Circumferential margin (CRM) is highly prog- nostic for rectal cancer recurrence; however, its significance in the setting after long-course neoadjuvant chemoradiation (nCR) is un- defined. METHODS: Review of a prospectively maintained database from 1998 to 2005 identified 463 patients with locally advanced rectal cancer (T3/T4 and/or N1) receiving nCR followed in 6 weeks by total mesorectal excision. CRM was analyzed for association with recurrence and survival using the maximal chi-square method. RESULTS: 70% of patients were noted to have clinical Stage III disease by endorectal ultrasound or rectal MRI. Following resection with a median follow-up of 35 months, local and distant relapse was noted 10 (2.2%) and 80 (17.3%) patients, respectively. 39 patients had pathologic CRM 2 mm and 4 developed local recurrence and 13 developed distant recurrence. Factors associated with overall re- currence included tumor response to nCR (% tumor destruction), pathologic tumor stage and nodal status, tumor grade, and CRM 2 mm. Disease free survival and overall survival were 40.9 and 66.5 months with CRM 2 mm and 78.6 and 89.5 months with CRM 2 mm (p 0.001 and 0.026). Multivariate analysis demonstrated CRM, pathological nodal status and tumor response to nCR to be independent predictors of overall recurrence (all p0.001). CONCLUSIONS: In this dataset of locally advanced rectal cancer treated with nCR both positive CRM and local recurrence were rare events and not clearly related. A CRM 2mm was associated with higher overall recurrence, independent of nodal status and response to nCR. 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S115Vol. 213, No. 3S, September 2011 Surgical Forum Abstracts
distribution”. Nearly twenty years later, the answer to whether socio-economic status impacts outcomes remains unresolved.
METHODS: Prospective data collected on bariatric surgical patientsat 555 facilities participating in the American Society for Metabolicand Bariatric Surgery Bariatric Surgery Center of Excellence(BSCOE) program were collected between June 2007 and Septem-ber 2009. 65,410 patients met inclusion criteria. Of these, 8,537patients had insurance provided by Centers of Medicare and Medic-aid Services (CMS); 7,090 with Medicare and 1,808 with Medicaidinsurance. Demographic, clinical, perioperative and postoperativedata were compared between patients with CMS insurance (CMS)and those whose surgery was covered by other insurers (non-CMS).
RESULTS: CMS patients differ sharply from those covered by pri-ate insurance in terms of mean age (years) (53.0 vs 44.3; p�.0001)reoperative medications (6.80 vs. 3.35; p�0001); percent of pa-
tients without postoperative medications (11.9% vs 31.3%:p�.0001); 90-day serious complications (2.28% vs. 0.93%;p�.0001) and 90-day mortality (0.26 vs 0.09; p�.0001).
CONCLUSIONS: Patients insured by Medicare and Medicaid un-dergoing bariatric surgery present with a higher risk profile and sufferworse postoperative outcomes compared to those covered by privatecarriers. While the CMS patients may have the most to gain from thesurgery, they also bring higher risks.
A financial analysis of payment per unit time for commongeneral surgery operationsAbhishek Chatterjee MD, MBA, Stefan D Holubar MD,Lilian Chen MD, Shirley A Montagne MBA, Joseph M Rosen MD,Joseph P Desimone MDDartmouth Hitchcock Medical Center, Lebanon, NH
INTRODUCTION: A payment per unit time model incorporates asurgeons reimbursement to the total care time spent in the operatingroom, post operative in-house and post operative clinic visit period.Our goal is to analyze and compare common outpatient operationsto common inpatient operations in general surgery by using thepayment per unit time method.
METHODS: Surgeon payments per case were recorded over the2009 financial year for 5 common outpatient and 4 common in-patient general surgery operations at our tertiary care health center.Total care time (TCT) was defined as the sum of the times spent bythe surgeon with the patient in the operating room in addition to 30minutes per day in the hospital and per office visit. We calculated thepayment per unit time by dividing the physician reimbursement percase by the total care time for each surgical case.
RESULTS: The average payment per time spent for inpatient oper-
tions was $455.73 and slightly more at $467.51 for outpatientprocedures. Partial colectomy with primary anastomosis had the leastpayment per time spent ($188.52)and laparoscopic gastric bypasshad the highest ($707.30).
CONCLUSIONS: The payment per time method shows a similarreimbursement process for common outpatient and inpatient gen-eral surgery cases performed at a tertiary care health center. However,partial colectomy surgery, while requiring the most total care time,has substantially less payment per time spent compared to othercases.
What is the significance of circumferential margin inlocally advanced rectal cancer after neoadjuvantchemoradiotherapy?Atthaphorn Trakarnsanga MD, Mithat Gonen PhD, Jinru Shia MD,Philip B Paty MD, FACS, José G Guillem MD, FACS, FASCRS,Larissa K F Temple MD, FACS, FRCSC,Garrett M Nash MD, MPH, FACS, Karyn A Goodman MD, MS,Martin R Weiser MD, FACSMemorial Sloan-Kettering Cancer Center, New York, NY
INTRODUCTION: Circumferential margin (CRM) is highly prog-nostic for rectal cancer recurrence; however, its significance in thesetting after long-course neoadjuvant chemoradiation (nCR) is un-defined.
METHODS: Review of a prospectively maintained database from1998 to 2005 identified 463 patients with locally advanced rectalcancer (T3/T4 and/or N1) receiving nCR followed in 6 weeks bytotal mesorectal excision. CRM was analyzed for association withrecurrence and survival using the maximal chi-square method.
RESULTS: 70% of patients were noted to have clinical Stage IIIdisease by endorectal ultrasound or rectal MRI. Following resectionwith a median follow-up of 35 months, local and distant relapse wasnoted 10 (2.2%) and 80 (17.3%) patients, respectively. 39 patientshad pathologic CRM � 2 mm and 4 developed local recurrence and13 developed distant recurrence. Factors associated with overall re-currence included tumor response to nCR (% tumor destruction),pathologic tumor stage and nodal status, tumor grade, and CRM �2 mm. Disease free survival and overall survival were 40.9 and 66.5months with CRM � 2 mm and 78.6 and 89.5 months with CRM� 2 mm (p� 0.001 and 0.026). Multivariate analysis demonstratedCRM, pathological nodal status and tumor response to nCR to beindependent predictors of overall recurrence (all p�0.001).
CONCLUSIONS: In this dataset of locally advanced rectal cancertreated with nCR both positive CRM and local recurrence were rareevents and not clearly related. A CRM � 2mm was associated withhigher overall recurrence, independent of nodal status and response
to nCR.
