Effect of Index Hospitalization Costs on Readmission
Original Investigation Research
Invited Commentary
Targeting Future Health Care Expenditure Reductions Alexander C. Schwed, MD; Christian de Virgilio, MD
A commonly held belief states that paying more for a product is an assurance of higher quality. The adage “you get what you pay for” has been the conventional wisdom for many prospective buyers, whether they are debating buying a new vs a used vehicle, buying an index vs a managed mutual fund, or Related article page 718 paying tuition at a public vs a private college. Recent US economic doldrums have given all of us pause, however, causing many to question the fiscal sagacity of overspending. Worse yet, evidence suggests that spending more for a product may not equate with better value. The same principle seems to apply to health care, as highlighted in this issue of JAMA Surgery. The well-written article by Ejaz and colleagues1 adds additional fuel to the fire surrounding the debate on health care spending. The authors found that increased spending at the time of index hospitalization for major abdominal surgery correlated with a higher likelihood of readmission. The United States cannot afford health care spendthrifts. After 5 years of historically low growth in health care expenditures, 2014 saw an increase in overall health care spending, which now accounts for 17.5% of the gross domestic product.2 The Affordable Care Act is believed to account for most of this trend. Hospital-based–care expenditures alone increased 4.1% in 2014, totaling $971.8 billion.2 Although Ejaz and colleagues describe the problem of unnecessary spending admirably, they do not tackle the harder ARTICLE INFORMATION Author Affiliations: Department of Surgery, Harbor–University of California, Los Angeles, Medical Center, Torrance. Corresponding Author: Christian de Virgilio, MD, Department of Surgery, Harbor–University of California, Los Angeles, Medical Center, 1000 W Carson St, PO Box 25, Torrance, CA 90509 ([email protected]). Published Online: February 24, 2016. doi:10.1001/jamasurg.2015.5556. Conflict of Interest Disclosures: None reported. REFERENCES 1. Ejaz A, Gonzalez AA, Gani F, Pawlik TM. Effect of index hospitalization costs on readmission among
question: What can we do to combat these spiraling costs? Additional studies are needed to identify and target the main drivers of the observed cost variations. Furthermore, we would argue that health care cost containment should begin with education. Surgeons, trainees, and students are largely unaware of the costs of care.3,4 However, studies have shown that surgeons can be trained to minimize costs without sacrificing quality. 5 Such education should start early. Timely and actionable feedback to residents with respect to the costs of care should be the next necessary step in surgical education. The American College of Surgeons National Surgical Quality Improvement Program’s Quality-in-Training project,6 which provides resident-specific feedback for operative outcomes, would seem a natural avenue to include resident-level cost data. Another approach is to attack the problem at the medical school level. Plans are already under way to create new medical schools run by health maintenance organizations.7 How graduates from such capitated systems will compare with students trained in more traditional fee-for-service models will be interesting. As the landscape of health care expenditure continues to change, with increases in overall costs a likely result for 2015, new efforts to undertake meaningful cost containment will be necessary. Including plans to use medical student, resident, and fellow training to address costs of care in a meaningful way may be one method of accomplishing this goal.
patients undergoing major abdominal surgery [published online February 24, 2016]. JAMA Surg. doi:10.1001/jamasurg.2015.5557. 2. Martin AB, Hartman M, Benson J, Catlin A; National Health Expenditure Accounts Team. National health spending in 2014: faster growth driven by coverage expansion and prescription drug spending. Health Aff (Millwood). 2016;35(1):150-160. 3. Jackson CR, Eavey RD, Francis DO. Surgeon awareness of operating room supply costs [published online November 1, 2015]. Ann Otol Rhinol Laryngol. 4. Okike K, O’Toole RV, Pollak AN, et al. Survey finds few orthopedic surgeons know the costs of the devices they implant. Health Aff (Millwood). 2014;33(1):103-109.
jamasurgery.com
5. Guzman MJ, Gitelis ME, Linn JG, et al. A model of cost reduction and standardization: improved cost savings while maintaining the quality of care. Dis Colon Rectum. 2015;58(11):1104-1107. 6. Sellers MM, Reinke CE, Kreider S, et al. American College of Surgeons NSQIP: quality in-training initiative pilot study. J Am Coll Surg. 2013;217(5): 827-832. 7. Goodnough A. Kaiser Permanente plans to open a medical school. New York Times. http://www .nytimes.com/2015/12/18/business/kaiser -permanente-plans-to-open-a-medical-school .html. Published December 17, 2015. Accessed December 19, 2015.
(Reprinted) JAMA Surgery August 2016 Volume 151, Number 8
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a Cornell University User on 08/18/2016
725
Original Investigation Research
Invited Commentary
Targeting Future Health Care Expenditure Reductions Alexander C. Schwed, MD; Christian de Virgilio, MD
A commonly held belief states that paying more for a product is an assurance of higher quality. The adage “you get what you pay for” has been the conventional wisdom for many prospective buyers, whether they are debating buying a new vs a used vehicle, buying an index vs a managed mutual fund, or Related article page 718 paying tuition at a public vs a private college. Recent US economic doldrums have given all of us pause, however, causing many to question the fiscal sagacity of overspending. Worse yet, evidence suggests that spending more for a product may not equate with better value. The same principle seems to apply to health care, as highlighted in this issue of JAMA Surgery. The well-written article by Ejaz and colleagues1 adds additional fuel to the fire surrounding the debate on health care spending. The authors found that increased spending at the time of index hospitalization for major abdominal surgery correlated with a higher likelihood of readmission. The United States cannot afford health care spendthrifts. After 5 years of historically low growth in health care expenditures, 2014 saw an increase in overall health care spending, which now accounts for 17.5% of the gross domestic product.2 The Affordable Care Act is believed to account for most of this trend. Hospital-based–care expenditures alone increased 4.1% in 2014, totaling $971.8 billion.2 Although Ejaz and colleagues describe the problem of unnecessary spending admirably, they do not tackle the harder ARTICLE INFORMATION Author Affiliations: Department of Surgery, Harbor–University of California, Los Angeles, Medical Center, Torrance. Corresponding Author: Christian de Virgilio, MD, Department of Surgery, Harbor–University of California, Los Angeles, Medical Center, 1000 W Carson St, PO Box 25, Torrance, CA 90509 ([email protected]). Published Online: February 24, 2016. doi:10.1001/jamasurg.2015.5556. Conflict of Interest Disclosures: None reported. REFERENCES 1. Ejaz A, Gonzalez AA, Gani F, Pawlik TM. Effect of index hospitalization costs on readmission among
question: What can we do to combat these spiraling costs? Additional studies are needed to identify and target the main drivers of the observed cost variations. Furthermore, we would argue that health care cost containment should begin with education. Surgeons, trainees, and students are largely unaware of the costs of care.3,4 However, studies have shown that surgeons can be trained to minimize costs without sacrificing quality. 5 Such education should start early. Timely and actionable feedback to residents with respect to the costs of care should be the next necessary step in surgical education. The American College of Surgeons National Surgical Quality Improvement Program’s Quality-in-Training project,6 which provides resident-specific feedback for operative outcomes, would seem a natural avenue to include resident-level cost data. Another approach is to attack the problem at the medical school level. Plans are already under way to create new medical schools run by health maintenance organizations.7 How graduates from such capitated systems will compare with students trained in more traditional fee-for-service models will be interesting. As the landscape of health care expenditure continues to change, with increases in overall costs a likely result for 2015, new efforts to undertake meaningful cost containment will be necessary. Including plans to use medical student, resident, and fellow training to address costs of care in a meaningful way may be one method of accomplishing this goal.
patients undergoing major abdominal surgery [published online February 24, 2016]. JAMA Surg. doi:10.1001/jamasurg.2015.5557. 2. Martin AB, Hartman M, Benson J, Catlin A; National Health Expenditure Accounts Team. National health spending in 2014: faster growth driven by coverage expansion and prescription drug spending. Health Aff (Millwood). 2016;35(1):150-160. 3. Jackson CR, Eavey RD, Francis DO. Surgeon awareness of operating room supply costs [published online November 1, 2015]. Ann Otol Rhinol Laryngol. 4. Okike K, O’Toole RV, Pollak AN, et al. Survey finds few orthopedic surgeons know the costs of the devices they implant. Health Aff (Millwood). 2014;33(1):103-109.
jamasurgery.com
5. Guzman MJ, Gitelis ME, Linn JG, et al. A model of cost reduction and standardization: improved cost savings while maintaining the quality of care. Dis Colon Rectum. 2015;58(11):1104-1107. 6. Sellers MM, Reinke CE, Kreider S, et al. American College of Surgeons NSQIP: quality in-training initiative pilot study. J Am Coll Surg. 2013;217(5): 827-832. 7. Goodnough A. Kaiser Permanente plans to open a medical school. New York Times. http://www .nytimes.com/2015/12/18/business/kaiser -permanente-plans-to-open-a-medical-school .html. Published December 17, 2015. Accessed December 19, 2015.
(Reprinted) JAMA Surgery August 2016 Volume 151, Number 8
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a Cornell University User on 08/18/2016
725
