Trends in performance of hospital outpatient procedures and associated 30-day costs among Medicare beneficiaries from 2011 to 2018

Laura G Burke; Ryan C Burke; E John Orav; Ava Ferguson Bryan; Tynan H Friend; Damien A Richardson; Ashish K Jha; Thomas C Tsai

doi:10.1016/j.hjdsi.2023.100718

Trends in performance of hospital outpatient procedures and associated 30-day costs among Medicare beneficiaries from 2011 to 2018

Healthc (Amst). 2023 Dec;11(4):100718. doi: 10.1016/j.hjdsi.2023.100718. Epub 2023 Oct 30.

Authors

Laura G Burke¹, Ryan C Burke², E John Orav³, Ava Ferguson Bryan⁴, Tynan H Friend⁵, Damien A Richardson⁶, Ashish K Jha⁷, Thomas C Tsai⁸

Affiliations

¹ Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; The Department of Emergency Medicine, Harvard Medical School, Department of Surgery, Brigham and Women's Hospital, USA. Electronic address: lgburke@bidmc.harvard.edu.
² The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; The Department of Emergency Medicine, Harvard Medical School, Department of Surgery, Brigham and Women's Hospital, USA.
³ Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Department of Surgery, The University of Chicago, Chicago, IL, USA.
⁵ The Warren Alpert Medical School of Brown University, Providence, RI, USA.
⁶ Department of Orthopaedic Surgery, The University of Arizona, College of Medicine, Phoenix, AZ, USA.
⁷ Brown University School of Public Health, Providence, RI, USA.
⁸ Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Department of Emergency Medicine, Harvard Medical School, Department of Surgery, Brigham and Women's Hospital, USA.

PMID: 37913606
DOI: 10.1016/j.hjdsi.2023.100718

Abstract

Background: United States healthcare has increasingly transitioned to outpatient care delivery. The degree to which Academic Medical Centers (AMCs) have been able to shift surgical procedures from inpatient to outpatient settings despite higher patient complexity is unknown.

Methods: This observational study used a 20% sample of fee-for-service Medicare beneficiaries age 65 and older undergoing eight elective procedures from 2011 to 2018 to model trends in procedure site (hospital outpatient vs. inpatient) and 30-day standardized Medicare costs, overall and by hospital teaching status.

Results: Of the 1,222,845 procedures, 15.9% occurred at AMCs. There was a 2.42% per-year adjusted increase (95% CI 2.39%-2.45%; p < .001) in proportion of outpatient hospital procedures, from 68.9% in 2011 to 85.4% in 2018. Adjusted 30-day standardized costs declined from $18,122 to $14,353, (-$560/year, 95% CI -$573 to -$547; p < .001). Patients at AMCs had more chronic conditions and higher predicted annual mortality. AMCs had a lower proportion of outpatient procedures in all years compared to non-AMCs, a difference that was statistically significant but small in magnitude. AMCs had higher costs compared to non-AMCs and a lesser decline over time (p < .001 for the interaction). AMCs and non-AMCs saw a similar decline in 30-day mortality.

Conclusions: There has been a substantial shift toward outpatient procedures among Medicare beneficiaries with a decrease in total 30-day Medicare spending as well as 30-day mortality. Despite a higher complexity population, AMCs shifted procedures to the outpatient hospital setting at a similar rate as non-AMCs.

Implications: The trend toward outpatient procedural care and lower spending has been observed broadly across AMCs and non-AMCs, suggesting that Medicare beneficiaries have benefited from more efficient delivery of procedural care across academic and community hospitals.

Keywords: Academic medical centers; Cost; Hospital teaching status; Medicare; Outpatient procedures.

Publication types

Observational Study

MeSH terms

Aged
Costs and Cost Analysis
Health Expenditures*
Hospitals, Teaching
Humans
Medicare
Outpatients*
United States