title: Understanding drivers of hospital charge variation for episodes of care among patients undergoing hepatopancreatobiliary surgery.
abstract: BACKGROUND
  Understanding factors associated with variation in hospital charges may help identify means to increase savings. The aim of the present study was to define potential variation in hospital charges associated with hepatopancreatobiliary(HPB) surgery.
  
  
  METHODS
  Patients who underwent an HPB procedure between 2009-2013 were identified. Total hospital charges were tabulated for room and board, surgical/anaesthesia services, medications, laboratory/radiology services and other miscellaneous charges.
  
  
  RESULTS
  Approximately 2545 patients underwent either a pancreas (66.8%) or liver/biliary (33.2%) resection. The mean total charges for all patients were $42,357 ± 33,745 (pancreas: $46,352 ± 34,932 versus the liver: $34,303 ± 29,639; P < 0.001). Morbidity (pancreas, range: 7-18%; liver, range: 9-18%) and observed:expected (O:E) length of stay (LOS)(pancreas, range: 0.67-1.64; liver, range: 1.06-3.35) varied among providers (both P < 0.001). While a peri-operative complication resulted in increased total hospital charges (complication: $66,401 ± 55,124 versus no complication: $39,668 ± 29,250; P < 0.001), total charges remained variable even among patients who did not experience a complication (P < 0.001). Surgeons within the lowest quartile of O:E LOS had lower total charges ($33 879 ± $27 398) versus surgeons in the highest quartile ($49,498 ± 40 971) (P < 0.001). Surgeons with the highest O:E LOS had higher across-the-board charges (operating room, highest quartile: $10,514 ± $4496 versus lowest quartile: $7842 ± $3706; medication, highest quartile: $1796 ± $3799 versus lowest quartile: $925 ± $2211; radiology, highest quartile: $2494 ± $4683 versus lowest quartile: $1424 ± $3247; P = 0.001; laboratory, highest quartile: $4236 ± $5991 versus lowest quartile: $3028 ± $3804; all P < 0.001).
  
  
  CONCLUSIONS
  After accounting for in-hospital complications, the total mean hospital charges for HPB surgery remained variable by case type and provider. While the variation in charges was associated with LOS, provider-level differences in across-the-board charges were also noted.
authors.affiliation: Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Taylor
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hundt
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D003365:Costs and Cost Analysis; D013505:Digestive System Surgical Procedures / Q000191:economics*; D017050:Episode of Care; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges / Q000639:trends*; D006801:Humans; D008107:Liver Diseases / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009873:Operating Rooms / Q000191:economics*; D010182:Pancreatic Diseases / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology