Pay for Obesity? Pay-for-Performance Metrics Neglect Increased Complication Rates and Cost for Obese Patients
Rates of surgical complications are increasingly being used for pay-for-performance reimbursement structures. We hypothesize that morbid obesity has a significant effect on complication rates and costs following commonly performed general surgical procedures.
We studied 30,502 patients who underwent cholecystectomy for cholecystitis and 6,390 patients who underwent appendectomy for acute appendicitis using administrative claims data from seven Blue Cross and Blue Shield Plans over a 7-year period (2002–2008). We compared 30-day complications as well as total 30-day direct medical costs for obese and non-obese patients. Multivariate regressions were performed to determine the relationship of morbid obesity to complications and cost.
Obese patients were more likely to have a complication within 30 days after surgery than non-obese patients (19.2% vs. 15.7% for cholecystectomy, p < 0.0001; 20.2% vs. 15.2%, p < 0.0001, for appendectomy). The mean total 30-day postoperative cost for obese patients were $1,109 higher following a cholecystectomy (p < 0.0001) and $666 higher following an appendectomy (p = 0.09).
Morbid obesity is associated with a higher rate of complications for two commonly performed general surgical procedures and is associated with higher costs for cholecystectomy. Pay-for-performance metrics should account for the increased risk of complications and higher cost in this population.
KeywordsObesity Appendectomy Cholecystectomy Pay for performance Cost
- 3.Kuhmerker K, Hartman T. Pay-for-Performance in State Medicaid Programs: A Survey of State Medicaid Directors and Programs. 2007.Google Scholar
- 4.CMS. Centers for Medicare and Medicaid Services: Hospital Quality Initiatives. 2010;2010.Google Scholar
- 9.Clark JM, Chang HY, Bolen SD, Shore AD, Goodwin SM, Weiner JP. Development of a Claims-Based Risk Score to Identify Obese Individuals. Popul Health Manag 2010.Google Scholar
- 12.Centers for Disease Control and Prevention (CDC). Differences in prevalence of obesity among black, white, and Hispanic adults - United States, 2006–2008. MMWR Morb Mortal Wkly Rep 2009;58:740–4.Google Scholar
- 13.Davenport DL, Xenos ES, Hosokawa P, Radford J, Henderson WG, Endean ED. The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. J Vasc Surg 2009;49:140,7, 147.e1; discussion 147.Google Scholar
- 15.Ryan AM. Has Pay-for-Performance Decreased Access for Minority Patients? Health Serv Res 2009.Google Scholar