Faced with increasing pressure to reduce costs, hospitals must minimize waste through continuous improvement of patient safety and quality. Timely provision of process and outcome data from clinical quality registries to clinicians has been shown to drive such improvements in healthcare.

value = quality/cost.

see healthcare cost.

The Neurosurgical Quality and Outcomes Research Laboratory is dedicated to improving outcomes, functional capacity and quality of life in patients undergoing cranial and spinal neurosurgical interventions. Our laboratory focuses on development of risk-factor based predictive models for outcomes and costs, quality data on comparative and cost-effectiveness, assessment of regional and racial disparities to neurosurgical access, epidemiologic trend analyses, participation in clinical trials,and evaluating intensity of resource utilization in neurosurgery. The laboratory has led several projects utilizing data from large-scale national administrative databases and trauma registry. Efforts to participate in the National Neurosurgical Quality and Outcomes Database (N2QOD)are underway.

Geographic variations in healthcare costs have been reported for many surgical specialties.

In a study, Asemota et al. sought to describe national and regional costs associated with transsphenoidal pituitary surgery (TPS).

Data from the Truven-MarketScan 2010-2014 was analyzed. They examined overall total, hospital/facility, physician, and out-of-pocket payments in patients undergoing TPS including technique-specific costs. Mean payments were obtained after risk-adjustment for the patient- and system-level confounders and estimated differences across regions.

The estimated overall annual burden was $43 million/year in our cohort. The average overall total payment associated with TPS was $35,602.30, hospital/facility payment was $26,980.45, physician payment was $4,685.95, and out-of-pocket payment was $2,330.78. Overall total and hospital/facility costs were highest in the West and lowest in the South (both P<0.001), while physician reimbursements were highest in the North-east and lowest in the South (P<0.001). There were no differences in out-of-pocket expenses across regions. On a national level, there were significantly higher overall total and hospital/facility payments associated with endoscopic compared to microscopic procedures (both P<0.001); there were no significant differences in physician payments nor out-of-pocket expenses between techniques. There were also significant within-region cost differences in the overall total, hospital/facility, and physician payments in both techniques as well as in out-of-pocket expenses associated with microsurgery. There were no significant regional differences in out-of-pocket expenses associated with endoscopic surgery.

These results demonstrate significant geographical cost disparities associated with TPS. Understanding the factors behind disparate costs is important for developing cost containment strategies 1).

Cost driver.

Asemota AO, Ishii M, Brem H, Gallia GL. Geographic Variation in Costs of Transsphenoidal Pituitary Surgery in the United States. World Neurosurg. 2020 Mar 4. pii: S1878-8750(20)30420-4. doi: 10.1016/j.wneu.2020.02.145. [Epub ahead of print] PubMed PMID: 32145414.
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