title: Increasing access to specialty surgical care: application of a new resource allocation model to bariatric surgery.
abstract: OBJECTIVE
  To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care.
  
  
  BACKGROUND
  The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost.
  
  
  METHODS
  Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated.
  
  
  RESULTS
  In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension.
  
  
  CONCLUSIONS
  Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.
authors.affiliation: *Stanford University School of Medicine, Stanford, CA †Stanford Graduate School of Business, Stanford, CA; and ‡Section of Minimally Invasive Surgery, Division of General Surgery, Stanford Department of Surgery, Stanford, CA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Leroux
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
authors.forename: Homero
authors.initials: H
authors.lastname: Rivas
mesh_terms: D050110:Bariatric Surgery / Q000191:economics*; D003363:Cost Control; D005260:Female; D006295:Health Resources; D006297:Health Services Accessibility / Q000191:economics*; D017722:Hospital Charges; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation