Surgical Episodes of Care for Price Transparency using the Episode Grouper for Medicare
This proof-of-concept explores the use of an episode grouper to more accurately identify the complete set of surgical services typically provided in a surgical episode of care and the corresponding range of prices, using colectomy for cancer as the example. Price transparency is an important policy...
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| Published in: | Annals of surgery Vol. 278; no. 6; pp. e1180 - e1184 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Lippincott Williams & Wilkins
01-12-2023
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| Online Access: | Get full text |
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| Summary: | This proof-of-concept explores the use of an episode grouper to more accurately identify the complete set of surgical services typically provided in a surgical episode of care and the corresponding range of prices, using colectomy for cancer as the example.
Price transparency is an important policy issue that will require surgeons to better understand the components and cost of care.
This study uses the Episode Grouper for Medicare (EGM) business logic to construct colectomy surgical episodes of care for cancer using Medicare claims data for the Boston Hospital Referral Region (HRR) from 2012-2015. Descriptive statistics show the mean reimbursement based on patient severity and stage of surgery along with the number of unique clinicians billing for care and the mix of services provided.
The EGM episode grouper identified 3,182 colectomies in Boston between 2012 and 2015 with 1,607 done for cancer. The mean Medicare allowed amount per case is $29,954 and varies from $26,605 to $36,850 as you move from low to high severity cases. The intra-facility stage is the most expensive ($23,175 on average) compared to the pre ($780) and post ($6,479) facility stages. There is tremendous heterogeneity in service mix.
Episode groupers are a potentially valuable tool for identifying variation in service mix and teaming patterns that correlate with total price. By looking at patient care holistically, stakeholders can identify opportunities for price transparency and care redesign that have heretofore been hidden. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0003-4932 1528-1140 |
| DOI: | 10.1097/SLA.0000000000005942 |