The association of Hospital Medicare beneficiary payer-mix, national quality rankings and outcomes following hepatopancreatic surgery.

American Journal of Surgery
Anghela Z ParedesTimothy M Pawlik

Abstract

We sought to determine the impact of payer-mix on post-operative outcomes among Medicare beneficiaries following hepatopancreatic surgery. Medicare beneficiaries who underwent hepatopancreatic surgery were identified. Hospital quality markers were obtained from the Hospital General Information dataset. Hospitals were dichotomized (low/average vs. high) based on Medicare patient days versus all patient days irrespective of payer type. High Medicare patient-mix hospitals were more likely to be ranked higher than the national average relative to safety of care (29.4% vs. 38.1%) and timeliness of care (15.4% vs. 26.3%) versus low burden Medicare hospitals (both p < 0.001). However, Medicare beneficiaries who had hepatopancreatic surgery at a high Medicare patient-mix hospital were at higher risk of a complication (OR = 1.13, 95%CI 1.04-1.22), and death within 30-days (OR = 1.37, 95%CI 1.23-1.53) following surgery. While hospitals caring for higher numbers of Medicare beneficiaries generally performed better on CMS quality indicators, these rankings did not equate to improved post-operative outcomes.

References

Jul 5, 2012·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Peter J KneuertzTimothy M Pawlik
Feb 28, 2013·JAMA : the Journal of the American Medical Association·Justin B DimickJohn D Birkmeyer
Oct 2, 2013·Journal of Patient Safety·J Matthew AustinRobert M Wachter
Apr 9, 2016·Journal of the American College of Surgeons·Olubode A OlufajoZara Cooper
Feb 2, 2018·The Journal of Trauma and Acute Care Surgery·Ambar MehtaJoseph V Sakran
Dec 1, 2018·Annals of Surgery·Katiuscha MerathTimothy M Pawlik

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