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Association of program-specific variation in bariatric surgery volume for Medicaid patients and access to care: a tale of inequality?

  • 2021 SAGES Oral
  • Published:
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Abstract

Background

Although patients with lower socioeconomic status are at higher risk of obesity, bariatric surgery utilization among patients with Medicaid is low and may be due to program-specific variation in access. Our goal was to compare bariatric surgery programs by percentage of Medicaid cases and to determine if variation in distribution of patients with Medicaid could be linked to adverse outcomes.

Methods

Using a state-wide bariatric-specific data registry that included 43 programs performing 97,207 cases between 2006 and 2020, we identified all patients with Medicaid insurance (n = 4780, 4.9%). Bariatric surgery programs were stratified into quartiles according to the percentage of Medicaid cases performed and we compared program-specific characteristics as well as baseline patient characteristics, risk-adjusted complication rates and wait times between top and bottom quartiles.

Results

Program-specific distribution of Medicaid cases varied between 0.69 and 22.4%. Programs in the top quartile (n = 11) performed 18,885 cases in total, with a mean of 13% for Medicaid patients, while programs in the bottom quartile (n = 11) performed 32,447 cases in total, with a mean of 1%. Patients undergoing surgery at programs in the top quartile were more likely to be Black (20.2% vs 13.5%, p < 0.0001), have diabetes (35.1% vs 29.5%, p < 0.0001), hypertension (55.1% vs 49.6%, p < 0.0001) and hyperlipidemia (47.6% vs 45.2%, p < 0.0001). Top quartile programs also had higher complication rates (8.4% vs 6.6%, p < 0.0001), extended length of stay (5.6% vs 4.0%, p < 0.0001), Emergency Department visits (8.1% vs 6.5%, p < 0.0001) and readmissions (4.7% vs 3.9%, p < 0.0001). Median time from initial evaluation to surgery date was also significantly longer among top quartile programs (200 vs 122 days, p < 0.0001).

Conclusions

Bariatric surgery programs that perform a higher proportion of Medicaid cases tend to care for patients with greater disease severity who experience delays in care and also require more resource utilization. Improving bariatric surgery utilization among patients with lower socioeconomic status may benefit from insurance standardization and program-centered incentives to improve access and equitable distribution of care.

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Authors and Affiliations

  1. Department of Surgery, Detroit Medical Center, Wayne State University, 3990 John R, Detroit, MI, 48201, USA

    Amy E. Somerset & Michael H. Wood

  2. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Aaron J. Bonham

  3. Department of Surgery, Henry Ford Health System, Detroit, MI, USA

    Arthur M. Carlin

  4. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA

    Jonathan Finks, Amir A. Ghaferi & Oliver A. Varban

Authors
  1. Amy E. Somerset
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  2. Michael H. Wood
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  3. Aaron J. Bonham
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  4. Arthur M. Carlin
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  5. Jonathan Finks
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  6. Amir A. Ghaferi
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  7. Oliver A. Varban
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Corresponding author

Correspondence to Amy E. Somerset.

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Disclosures

Carlin, Ghaferi, Finks, and Varban receive salary support from Blue Cross Blue Shief for participation in the Michigan Bariatric Surgery Collaborative. Wood, Somerset, and Bonham have no conflicts of interest or financial ties to disclose.

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Somerset, A.E., Wood, M.H., Bonham, A.J. et al. Association of program-specific variation in bariatric surgery volume for Medicaid patients and access to care: a tale of inequality?. Surg Endosc 37, 8570–8576 (2023). https://doi.org/10.1007/s00464-023-10411-4

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  • DOI: https://doi.org/10.1007/s00464-023-10411-4

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