Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Nov;15(11):1994-2001.
doi: 10.1016/j.soard.2019.06.029. Epub 2019 Jul 2.

Financial impact of improving patient care setting selection after bariatric surgery

Margaret E Smith  1 , Aaron J Bonham  2 , Oliver A Varban  2 , Jonathan F Finks  2 , Arthur M Carlin  3 , Amir A Ghaferi  2
Affiliations
Observational Study

Financial impact of improving patient care setting selection after bariatric surgery

Margaret E Smith et al. Surg Obes Relat Dis. 2019 Nov.

Abstract

Background: Potentially avoidable emergency department (ED) visits are a significant source of excess healthcare spending. Despite improvement in postoperative readmissions, 20% of bariatric surgery patients use the ED postoperatively. Many of these visits may be appropriately managed in lower-acuity centers.

Objective: We sought to evaluate the economic impact of shifting potentially avoidable ED visits after bariatric surgery to lower-acuity centers.

Setting: Statewide quality improvement collaborative.

Methods: We performed an observational study of patients who underwent bariatric surgery between 2011 and 2017 using a linked data registry, including clinical data from a large-quality improvement collaborative and payment data from a statewide value collaborative. Postoperative ED visits and readmission rates were determined. Ninety-day ED and urgent care center (UCC) visit claims were matched to a clinical registry. Price-standardized payments for UCC and ED visits without admission were compared.

Results: Among the 36,071 patients who underwent bariatric surgery, 8.4% presented to the ED postoperatively. Approximately 50% of these visits resulted in readmission. Three hundred eighty-eight ED visits without readmission (i.e., potentially avoidable ED visits) and 110 UCC encounters with claims data were identified. Triaging a potentially avoidable ED visit to an UCC would generate a savings of $4238 per patient, reducing spending in this cohort by $1.6 million.

Conclusion: Shifting potentially avoidable ED visits after bariatric surgery could result in significant cost savings. Efforts to improve patients' selection of healthcare setting and increase utilization of lower-acuity centers may serve as a template for appropriately meeting the needs of patients and containing spending after bariatric surgery.

Keywords: Bariatric surgery; Cost containment; Emergency department visit; Health policy; Nonurgent ED visit; Urgent care center.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Postoperative emergency department visit and readmission rates from 2007 to 2017.
Figure 2.
Figure 2.
Interquartile range of potentially avoidable Emergency Department visit episode spending.
Figure 3.
Figure 3.
Interquartile range of potentially avoidable Urgent Care Center visit episode spending.
See this image and copyright information in PMC

References

    1. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. https://www.facs.org/quality-programs/mbsaqip. Accessed March 19, 2018.
    1. Abraham CR, Werter CR, Ata A, et al. Predictors of Hospital Readmission after Bariatric Surgery. J Am Coll Surg. 2015;221(1):220–227. - PubMed
    1. Encinosa WE, Bernard DM, Du D, Steiner CA. Recent improvements in bariatric surgery outcomes. Med Care. 2009;47(5):531–535. - PubMed
    1. Mora-Pinzon MC, Henkel D, Miller RE, et al. Emergency department visits and readmissions within 1 year of bariatric surgery: A statewide analysis using hospital discharge records. Surgery. 2017;162(5):1155–1162. - PubMed
    1. Morton J The first metabolic and bariatric surgery accreditation and quality improvement program quality initiative: decreasing readmissions through opportunities provided. Surg Obes Relat Dis. 2014;10(3):377–378. - PubMed

Publication types

MeSH terms