How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy
| Autor: | Weiland, Dennis Edward, Caruso, Daniel Martin, Wesche, Daniel Eric, Bay, Ralph Curtis |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Adolescent Decision Trees Managed Care Programs Arizona Managed care contracts Contract Services Length of Stay Middle Aged Laparoscopic cholecystectomy Cholecystectomy Laparoscopic Cholelithiasis Commentary Costs and Cost Analysis Humans Cholecystectomy Female Hospital Costs Aged Retrospective Studies |
| Zdroj: | JSLS : Journal of the Society of Laparoendoscopic Surgeons |
| ISSN: | 1938-3797 1086-8089 |
| Popis: | Background and Objectives: Maricopa Medical Center (MMC) was found to have higher charges and length-of-stays than 16 other regional hospitals in an analysis of DRG categories for gallbladder disease. These comparative figures identified MMC as being inefficient and demanded review to determine the reasons for the inefficiencies. Methods: In an attempt to determine the reason for inefficiency of charges and length-of-stay for the laparoscopic portion of laparoscopic cholecystectomy, matched pairs of open cholecystectomy and converted laparoscopic cholecystectomy from a data base of 633 patients with cholecystectomies were reviewed. Thirty-five matches for age, sex and similar diagnosis were successful. Results: Matched pair evaluation disclosed a $6,880 difference in charges, which was attributed solely to the charge for laparoscopy. Subsequent chart analysis showed a high charge for instrumentation, prolonged anesthesia and operative times and longer preoperative delays before surgery. Moreover, no matter what the conversion rate is, open cholecystectomy was more cost effective. However, if there is a conversion rate of 5%, total hospital charges for laparoscopic cholecystectomy would have to be reduced to $12,679 (a reduction of $3,332 from $16,011) to make laparoscopic cholecystectomy cost-effective. Conclusions: Cost-effective decision tree analysis of matched pair comparisons and sensitivity analysis proves to be an effective technique in evaluating the cost-effectiveness of laparoscopic cholecystectomy in a hospital population. |
| Databáze: | OpenAIRE |
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