title: Spending On Care After Surgery Driven By Choice Of Care Settings Instead Of Intensity Of Services.
abstract: The rising popularity of episode-based payment models for surgery underscores the need to better understand the drivers of variability in spending on postacute care. Examining postacute care spending for fee-for-service Medicare beneficiaries after three common surgical procedures in the period 2009-12, we found that it varied widely between hospitals in the lowest versus highest spending quintiles for postacute care, with differences of 129 percent for total hip replacement, 103 percent for coronary artery bypass grafting (CABG), and 82 percent for colectomy. Wide variation persisted after we adjusted for the intensity of postacute care. However, the variation diminished considerably after we adjusted instead for postacute care setting (home health care, outpatient rehabilitation, skilled nursing facility, or inpatient rehabilitation facility): It decreased to 16 percent for hip replacement, 4 percent for CABG, and 21 percent for colectomy. Health systems seeking to improve surgical episode efficiency should collaborate with patients to choose the highest-value postacute care setting.
authors.affiliation: Lena M. Chen (lenac@umich.edu) is an assistant professor in the Department of Internal Medicine and at the Institute for Healthcare Policy and Innovation, University of Michigan Health System, and the Center for Healthcare Outcomes and Policy (CHOP), University of Michigan.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Chen
authors.affiliation: Edward C. Norton is a professor of health management and policy in the School of Public Health, a professor of economics, a research associate at the National Bureau of Economic Research, and a professor at the Institute for Healthcare Policy and Innovation and at CHOP, University of Michigan Health System and University of Michigan.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Norton
authors.affiliation: Mousumi Banerjee is a research professor at the School of Public Health, and the Institute for Healthcare Policy and Innovation, and CHOP, University of Michigan Health System and University of Michigan.
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.affiliation: Scott E. Regenbogen is an assistant professor of surgery, chief of the Division of Colorectal Surgery, and an assistant professor at the Institute for Healthcare Policy and Innovation and CHOP, University of Michigan Health System and University of Michigan.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
authors.affiliation: Anne H. Cain-Nielsen is a senior statistician in the Department of Surgery, the Institute for Healthcare Policy and Innovation, and CHOP, University of Michigan Health System and University of Michigan.
authors.forename: Anne H
authors.initials: AH
authors.lastname: Cain-Nielsen
authors.affiliation: John D. Birkmeyer was executive vice president of the Dartmouth-Hitchcock Health System, in Lebanon, New Hampshire, at the time this article was written.
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018588:Fee-for-Service Plans; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D006278:Medicare; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D019467:Subacute Care / Q000191:economics / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States
keywords: Cost of Health Care; Health Policy; Health Services; Hospitals; Quality Of Care