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Medicare costs for post-operative complications vary widely, show few ties to quality, study shows

Those cared for at higher-cost hospitals have no greater chance of survival, the study found.
By Beth Jones Sanborn , Managing Editor

A new study by researchers at University of Michigan Health and Brigham and Women's Hospital shows major variation among the costs of care for complications that arise after surgery.

The study, authored by U-M researchers and a surgeon from Brigham and Women's Hospital and published in the Journal of the American Medical Association shows cost can be three times higher for patients with the same complications from the same surgery. At the same time, and those cared for at higher-cost hospitals have no greater chance of survival, the study found.

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Researchers analyzed Medicare records from more than 576,000 people over 65 years old who had undergone one of four common operations; all of them had a hip replaced, an aortic aneurysm repaired, or a section of lung or intestine removed on an elective basis over a four-year period ending in 2012.

More than one in every 10 patients who had an aorta, lung or intestinal operation suffered one of the eight major complications the team studied: infections, blood clots, serious bleeding, pneumonia, heart attack and lung or kidney failure. A little more than one in 50 of the hip replacement patients did too, the study showed.

Researchers said they were not surprised to find that Medicare paid more for patients who suffered major complications than ones who did not. However, when they standardized prices for hospitals nationwide, they found "substantial variation in care, and cost" after major complications occurred despite having accounted for the type of complication as well as other factors.

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Specifically, Medicare payments for patients rescued at higher-cost hospitals were actually "two-to-three-fold" higher than those at lower-cost-of-rescue facilities. For example, the cost of an aortic aneurysm repair ranged from $60,456 down to $23,261; a colectomy ran $56,787 down to $22,853; a pulmonary resection varied from $63,117 down to $21,325; and a total hip replacement ranged from $41,354 down to $19,028.

"This represents a real opportunity for hospitals to be more efficient in how they prevent and manage complications, for how Medicare incentivizes better care at lower costs," U-M surgeon Hari Nathan said.

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Study results also showed that high cost of care did not equal better quality care, an assumption often made by consumers. Hospitals with the highest cost of rescue had higher rates of all complications, but were not more likely than lower-cost hospitals to save a patient from a major complication or to give them better odds of surviving the first month following their operation, results showed.

Additionally, death from complications occurred in nearly 18 percent of patients who had a section of lung or intestine removed, and in 3.4 percent of elective hip replacement patients, the study said.

Twitter: @BethJSanborn