American Surgical Association

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Characterizing and Assessing the Effect of Surgery on Pre-Operative Super Utilizers: A Study of​ Medicare Expenditure
Aslam Ejaz*, Madison Hyer*, Diamantis Tsilimigras*, Jordan Cloyd*, Fabio Bagante*, Susan White*, Timothy M. Pawlik
The Ohio State University, Columbus, OH

OBJECTIVE(S): Rising health care costs are increasingly burdensome for Medicare partly due to super-utilizers who consume a disproportionate amount of health care services. We sought to characterize pre-operative super-utilizers and examine the effect of surgery on service utilization among patients undergoing major elective surgery.
METHODS: Patients aged >65 years who underwent abdominal aortic aneurysm repair(AAA), coronary artery bypass grafting(CABG), colectomy, or total hip replacement between 2013-2015 were identified using 100% Medicare Inpatient and Outpatient Standard Analytic Files(SAFs). Total Medicare inpatient and outpatient expenditures the year before surgery, during the surgical episode, and the year following surgery were analyzed using repeated measures, mixed-effects gamma regression.
RESULTS: Among 603,105 patients identified, hip replacement was the most common surgery(43.7%) followed by colectomy(24.5%), CABG(23.7%), and AAA(8.3%). Super-utilizers accounted for 39.6% ($1.7 billion) of all annual preoperative Medicare expenditures despite representing only 5.3% of the total cohort. Median annual preoperative expenditure was 5-times higher among super-utilizers($43,800) compared with low-utilizers($8,000)(p<0.05). In the year following surgery, median Medicare expenditure per beneficiary was nearly 10-times greater among super-($11,600) versus low-($1,200) utilizers(p<0.05)(Figure). Among super-utilizers, there was an approximately 75% reduction in total Medicare expenditure following surgery - a savings of approximately $15,000-30,000/year per beneficiary.
CONCLUSIONS: Among super-utilizers, surgical intervention significantly reduced annual Medicare expenditure by 75%, saving up to $30,000 per patient on average. Earlier surgical intervention may lead to greater healthcare cost savings.

* By Invitation


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