World Journal of Surgery

, Volume 42, Issue 9, pp 2969–2979 | Cite as

Hospital Teaching Status and Medicare Expenditures for Hepato-Pancreato-Biliary Surgery

  • Qinyu Chen
  • Fabio Bagante
  • Katiuscha Merath
  • Jay Idrees
  • Eliza W. Beal
  • Jordan Cloyd
  • Mary Dillhoff
  • Carl Schmidt
  • Adrian Diaz
  • Susan White
  • Timothy M. Pawlik
Original Scientific Report



The association of hospital teaching status and overall expenditures has not been studied among patients undergoing hepato-pancreato-biliary (HPB) surgery. We sought to define the impact of hospital teaching intensity on payments and charges associated with (HPB) surgery from the payer perspective.


Surgical patients undergoing HPB procedures were identified using 2013–2015 Medicare Provider Analysis and Review (MEDPAR) data. Hospital teaching intensity was categorized based on hospital resident-to-bed ratio: non-teaching (NTH: 0), minor teaching (minor-TH: 0–0.363), and major teaching (major-TH:  > 0.363). Risk-adjusted price-standardized Medicare payments were assessed and compared among HPB surgical patients at NTH versus major-TH.


A total of 8863 patients underwent HPB (NTH: n = 1239, 14.0%; minor-TH: n = 3202, 36.1%; major-TH: n = 4422, 49.9%). Patient comorbidities did not vary across hospital according to teaching intensity (p = 0.27). Mean risk-adjusted Medicare payment at a major-TH was $29,541 versus $19,345 at a NTH (Δ-payment: + $10,195; p < 0.001). Differences in Medicare payments associated with hospital teaching status persisted when the risk-adjusted price was standardized to remove social subsidies and regional variation in costs (NTH: $19,760 vs. major-TH: $28,382; Δ-payment:  + $8623). Major-TH had higher total charges submitted to Medicare versus NTH (NTH: $100,583 vs. major-TH: $120,498; Δ-charge = + $19,915), including charges for accommodations, laboratory, and blood utilization (all p < 0.05). Compared with NTH, major-TH had lower morbidity (22.6 vs. 19.0%), serious complications (13.0 vs. 10.5%) and 30-day mortality (4.8 vs. 2.3%) (all p < 0.05).


Major-TH was associated with higher Medicare expenditures than NTH among HPB surgical patients. These differences were attributable, in part, to higher submitted charges for hospital-based services. While associated with higher payments and charges, TH did have better short-term outcomes compared with NTH.


Compliance with ethical standards

Conflict of interest

All authors declare that they have no disclosures to report.

Supplementary material

268_2018_4566_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Qinyu Chen
    • 1
  • Fabio Bagante
    • 1
  • Katiuscha Merath
    • 1
  • Jay Idrees
    • 1
  • Eliza W. Beal
    • 1
  • Jordan Cloyd
    • 1
  • Mary Dillhoff
    • 1
  • Carl Schmidt
    • 1
  • Adrian Diaz
    • 1
  • Susan White
    • 2
  • Timothy M. Pawlik
    • 1
  1. 1.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical CenterThe Ohio State UniversityColumbusUSA
  2. 2.Clinical, Health Information Management and Systems Division, Wexner Medical CenterThe Ohio State UniversityColumbusUSA

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