Abstract 4078: Effect of Meeting Leapfrog Group Volume Thresholds on Hospital Charges For Coronary Artery Bypass Graft Surgeries
Background - The Leapfrog group, a private entity formed by representatives from 155 major health insurance purchasers recommends that members contract for selected complex surgical procedures only with hospitals that meet minimum volume thresholds in order to achieve better outcomes. While there is considerable evidence to indicate that high volume hospitals and high volume surgeons have better outcomes in terms of lower in-hospital mortality, there is paucity of data regarding the impact of hospital volume on hospital charges. The object of our study was to examine the association between hospital volume and hospital charges for coronary artery bypass graft surgery (CABG).
Methods - We used data from the Nationwide Inpatient Sample for the year 2003. All patients aged > 17 years and who underwent CABG as the primary procedure were selected for analysis. Hospital volumes were calculated as recommended by Leapfrog group evidence based hospital referral criteria. Hospitals performing 450 or more cases of CABG per year were categorized as high volume hospitals. Hospital charges were log transformed due to skewed distribution. The association between hospital volume and charges were examined my multivariable linear regression analysis using the Generalized Estimating Equations method to adjust for clustering effects. The confounding effects of age, sex, type of CABG, type of admission, primary diagnosis, and co-morbid conditions was adjusted.
Results - In this sample, 60291 patients aged 18 years and above underwent CABG. Out of the 233 hospitals that performed CABG, 40 met the Leapfrog volume thresholds (high volume). Close to 43% of surgeries were performed in high volume hospitals. The mean charge per discharge was $77,133 and $88,068 at high and low volume hospitals respectively. After adjusting for confounding factors, high volume hospitals were associated with 15% lower charge when compared to low volume hospitals (p = 0.03). For each 100 case increase in volume, hospital charges reduced by 3.5% (p = 0.002).
Conclusions - Regionalizing surgical procedures could lower health care expenditures. However, potential barriers and facilitators to regionalization should be explored before embarking on regionalizing complex surgical procedures.