Studies from University of Texas Health Science Center Yield New Data on Managed Care (Association of Cumulative Colorectal Surgery Hospital Costs, Readmissions, and Emergency Department/observation Stays With Insurance Type): Managed Care

2023 MAR 06 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Investigators publish new report on Managed Care. According to news reporting originating in San Antonio, Texas, by NewsRx journalists, research stated, “Background/PurposeMedicare’s Hospital Readmission Reduction Program disproportionately penalizes safety-net hospitals (SNH) caring for vulnerable populations. This study assessed the association of insurance type with 30-day emergency department visits/observation stays (EDOS), readmissions, and cumulative costs in colorectal surgery patients.MethodsRetrospective inpatient cohort study using the National Surgical Quality Improvement Program (2013-2019) with cost data in a SNH.”

Funders for this research include NIH National Center for Advancing Translational Sciences (NCATS), Office of the Director, NIH, Clinical Translational Science from the National Center for Advancing Translational Sciences, NIH from the National Institute on Aging, NIH.

The news reporters obtained a quote from the research from the University of Texas Health Science Center, “The odds of EDOS and readmissions and cumulative variable (index hospitalization and all 30-day EDOS and readmissions) costs were modeled adjusting for frailty, case status, presence of a stoma, and open versus laparoscopic surgery.ResultsThe cohort had 245 private, 195 Medicare, and 590 Medicaid/uninsured cases, with a mean age 55.0 years (SD = 13.3) and 52.9% of the cases were performed on male patients. Most cases were open surgeries (58.7%). Complication rates were 41.8%, EDOS 12.0%, and readmissions 20.1%. Medicaid/uninsured had increased odds of urgent/emergent surgeries (aOR = 2.15, CI = 1.56-2.98, p< 0.001) and complications (aOR = 1.43, CI = 1.02-2.03, p = 0.042) versus private patients. Medicaid/uninsured versus private patients had higher EDOS (16.6% versus 4.1%) and readmissions (22.9% versus 14.3%) rates and higher odds of EDOS (aOR = 4.81, CI = 2.57-10.06, p< 0.001), and readmissions (aOR = 1.62, CI = 1.07-2.50, p = 0.025), while Medicare patients had similar odds versus private. Cumulative variable cost %change was increased for Medicare and Medicaid/uninsured, but Medicaid/uninsured was similar to private after adjusting for urgent/emergent cases.ConclusionsIncreased urgent/emergent cases in Medicaid/uninsured populations drive increased complications odds and higher costs compared to private patients, suggesting lack of access to outpatient care. SNH care for higher cost populations, receive lower reimbursements, and are penalized by value-based programs.”

According to the news reporters, the research concluded: “Increasing healthcare access for Medicaid/uninsured patients could reduce urgent/emergent surgeries, resulting in fewer complications, EDOS/readmissions, and costs.”

This research has been peer-reviewed.

For more information on this research see: Association of Cumulative Colorectal Surgery Hospital Costs, Readmissions, and Emergency Department/observation Stays With Insurance Type. Journal of Gastrointestinal Surgery, 2023. Journal of Gastrointestinal Surgery can be contacted at: Springer, One New York Plaza, Suite 4600, New York, Ny, United States. (Elsevier - www.elsevier.com; Journal of Gastrointestinal Surgery - http://www.journals.elsevier.com/journal-of-gastrointestinal-surgery/)

Our news correspondents report that additional information may be obtained by contacting Paula K. K. Shireman, University of Texas Health Science Center, Dept. of Surgery, San Antonio, TX 78229, United States. Additional authors for this research include Michael A. Jacobs, Jasmine C. Tetley, Jeongsoo Kim, Susanne Schmidt, Chen-Pin Wang, Bradley B. B. Brimhall, Virginia Mika, Laura S. S. Manuel and Paul Damien.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1007/s11605-022-05576-7. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

(Our reports deliver fact-based news of research and discoveries from around the world.)