Nationwide Trends in Hospital Charges Hetal Fichadia MD, Juliana E - PowerPoint PPT Presentation

Immediate Breast Reconstruction - Nationwide Trends in Hospital Charges Hetal Fichadia MD, Juliana E Hansen MD, FACS Plastic and Reconstructive Surgery Oregon Health and Sciences University

Introduction • We sought to analyze the trends in total hospital charges and length of stay among patients undergoing immediate breast reconstruction – both implant based and autologous.

Methods • Nationwide Inpatient Sample was queried from 2000 to 2009 using ICD-9 codes to identify patients undergoing mastectomy and immediate reconstruction 1 .

Methods • This data was analyzed to follow the rates of immediate reconstruction, total hospital charges (in dollars) and length of stay over this time frame. • Statistical significance was assessed by linear regression and ANOVA using SPSS.

Results • After applying discharge weights, a total of 782,418 patients underwent mastectomy during the study period, out of which 253,238 (32.3%) underwent immediate reconstruction. • Rate of immediate reconstruction increased from 26.3% in 2000 to 43.9% in 2009 (p<0.001)

Mastectomy - charges 30000 25000 Total charges (in dollars) 20000 15000 2000 2009 10000 5000 0 Unilateral Bilateral Mastectomy charges – Comparison 2000 vs 2009

Expected vs actual charges for mastectomy 20000 18000 Total hospital charges (in dollars) 16000 14000 12000 10000 8000 6000 4000 2000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Actual charges- mastectomy Expected charges - mastectomy

Autologous reconstruction charges 60000 50000 Total charges (in dollars) 40000 30000 2000 2009 20000 10000 0 Unilateral Bilateral Autologous Reconstruction - Comparision 2000 vs 2009

Expected vs actual increase in charges autologous - bilateral Total hospital charges (in dollars) 55000� 45000� 35000� 25000� 15000� 2000� 2001� 2002� 2003� 2004� 2005� 2006� 2007� 2008� 2009� Actual� charges� bilateral� (Median)� Expected� charges� bilateral� �

Expected vs actual increase in charges autologous - unilateral Total hospital charges (in dollars) 45000� 35000� 25000� 15000� 2000� 2001� 2002� 2003� 2004� 2005� 2006� 2007� 2008� 2009� Actual� charges� for� unilateral� (median)� Expected� charges� for� unilateral� �

Implant-based reconstruction charges 50000 45000 40000 Total charges (in dollars) 35000 30000 25000 2000 20000 2009 15000 10000 5000 0 Unilateral Bilateral Implant-based reconstruction - Comparision 2000 vs 2009

Expected vs actual charges Implant based - unilateral 40000� Total hospital charges (in dollars) 35000� 30000� 25000� 20000� 15000� 10000� 2000� 2001� 2002� 2003� 2004� 2005� 2006� 2007� 2008� 2009� Actual� charges� for� unilateral� (median)� Expected� charges� for� unilateral� �

Expected vs actual charges Implant based - bilateral 50000� Total hospital charges (in dollars) 45000� 40000� 35000� 30000� 25000� 20000� 15000� 10000� 2000� 2001� 2002� 2003� 2004� 2005� 2006� 2007� 2008� 2009� Actual� charges� bilateral� (Median)� Expected� charges� bilateral� �

• Increase in charges for breast reconstruction procedures are significantly higher than the 3.5% per year rise in Medicare spending from 1992 to 2006 2 . • Adjusting for inflation using the PHCE (Personal Health Care Expenditure) Price Index from the CMS office of actuary allows for healthcare expenditure rise of 141% in this study period 3 .

Length of Stay • The mean length of stay for patients undergoing implant-based reconstruction changed from 2.2 to 2.04 days. • Mean length of stay for patients undergoing autologous reconstruction changed from 3.86 to 3.06 days.

Conclusions • The total charges for all immediate breast reconstruction cases have shown a disproportionate increase over the past decade. • Further studies are needed to identify the factors

Explanations • Use of ADMs • Costlier implants • Increase in microvascular reconstruction • Increase in complexity of cases • Increased mark-up of medical devices

References 1. HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2007-2009. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup- us.ahrq.gov/nisoverview.jsp 2. http://www.ahrq.gov/research/findings/factsheets /costs/expriach/index.html 3. http://meps.ahrq.gov/about_meps/Price_Index.sh tml