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19-03-2013 | Surgery | Article

Integrated delivery system benefits do not extend to inpatient surgery


Free abstract

medwireNews: US integrated delivery systems (IDS) do not improve the quality of inpatient surgical care, research shows.

Compared with non-IDS-affiliated hospitals, patients treated in IDS hospitals had similar rates of operative mortality, complications, and readmissions for coronary artery bypass graft (CABG) surgery, hip replacement, and back surgery.

Patients who underwent a colectomy at an IDS hospital did have significantly lower rates of readmission, but mortality and complication rates were similar.

"Total and component episode costs for patients treated in IDS-affiliated hospitals were also largely indistinguishable from those for patients undergoing surgery in non-IDS-affiliated facilities," report David Miller (University of Michigan, Ann Arbor, USA) and colleagues.

The IDS, defined as a network of healthcare providers and organizations that provide a continuum of services, is typically part of the Accountable Care Organization (ACO), the services of which include financial incentives that reward the provider for meeting cost and quality benchmarks.

Data supporting the benefits of the ACO are largely derived from ambulatory care populations, explain Miller and colleagues.

Their latest findings, published in JAMA: Surgery, suggest that these benefits might not extend to the surgical setting.

Using national Medicare data, the researchers compared the quality and cost of inpatient surgery among those undergoing CABG surgery, hip replacement, back surgery, or colectomy at IDS-affiliated or non-IDS-affiliated hospitals.

There was no overall difference in quality of care, a measure that included operative mortality, complications, and readmissions, between those treated at IDS- and non-IDS-affiliated hospitals.

The only significant difference was for readmission rates for colectomy, which were lower at the IDS hospitals (12.6%) compared with the non-IDS hospitals (13.5%).

Regarding cost, the adjusted total payments for hip replacement were 4% lower in the IDS-affiliated hospitals, a difference that was largely driven by lower expenditures for post discharge care.

"Episode payments differed by 1% or less for the remaining procedures," write Miller and colleagues.

In an accompanying editorial, David Penson (Vanderbilt University, Nashville, Tennessee, USA) writes that, while the effect of ACOs on quality in a surgical setting is likely to be small, such a care model could still benefit the practices of surgeons.

He points out that "most surgical procedures in the US in 2013 will be performed in the outpatient setting," and the current study implies that this is one place that ACOs could have an effect on cost savings.

By medwireNews Reporters

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