A study of more than 200,000 Medicare patients who had common surgical procedures shows that, compared to the general population, they underwent far fewer minimally invasive operations, whose benefits include lower rates of complications and readmissions, along with shorter hospital stays.
A report of the findings, published in Surgical Endoscopy, suggests that the disparities short-circuit the potential for better care and cost savings, researchers said. Specifically, they said it represents an opportunity for Medicare, and other payers, to spend healthcare dollars in a way that rewards high-value care over low-value care.
The Centers for Medicare and Medicaid Services accounts for the second largest government expenditure behind the military, and Medicare -- the federal insurance program for those over 65, younger disabled people and those with end-stage kidney disease -- insures roughly a quarter of all Americans. All told, Medicare expenditures were nearly $600 billion in 2016.
In an effort to highlight potential efficiencies and cost savings, the research team focused on the use of minimally invasive surgery, or MIS, in elderly patients. Previous studies have shown that MIS is associated with lower postoperative complication rates, readmission rates, mortality and healthcare costs, as well as shorter lengths of stay, they said.
These improved outcomes stand to benefit elderly patients as much as nonelderly patients, yet MIS is still underused, according to the report. For select operations, the use of MIS nearly eliminates the risk of a wound infection, and for others, it halves the overall complication rate.
Researchers said complication prevention is a key goal in older, often frail patients because a single complication can lead to a cascade of harmful and costly events.
The report focused on data for seven surgical procedures: cholecystectomy (gallbladder removal), bariatric, colectomy, hysterectomy, inguinal hernia, thoracic and ventral hernia. An analysis of Medicare costs showed that MIS costs were lower for four procedures, and overall, MIS use was greater in the general population than in the Medicare population for all procedures. Readmission rates after MIS were lower for six procedures -- all but inguinal hernia -- and MIS was associated with less time in the hospital for six procedures.
Reducing 30-day readmission rates is a top goal for many hospitals and health systems, as CMS levies financial penalties on organizations that don't show improvement in that area compared to their peers.