1. A National Comparison of Laparoscopic versus Open Colectomy Using NSQIP
Anthony J Senagore M.D, M.S., M.B.A.
VP/CAO, Spectrum Health
Professor of Surgery, Michigan State University
Grand Rapids, MI

2. Anxiety About Health Care ($$)
Employers: premiums growing at 2-3x wages; affecting profits and competitiveness
Consumers: higher out-of-pocket costs keeping real wage growth down; fear of losing insurance; lack of information for confident decisions
Insurers: pressure from employer customers to control rising costs
Doctors and Hospitals: Medicare reimbursement rates; administrative challenges of data collection, performance measurement and reporting

4. Defining Value Risk Adjusted Comparison Outcomes defined
Resource Consumption
Transparency of Reporting
Hospital/Physician Comparison
Informed Consent

5. Complex Interactions:Quality
Hospital Systems
Diagnostic Equipment/access
Staffing
OR equipment
Operative Technique
Postoperative Care
Preoperative Evaluation/Optimization
Enhanced Recovery Protocols
Post-Discharge care plans

6. Sources of Surgical Cost
Hospital Issues
Beds
Personnel
OR’s
Diagnostic equipment
Doctor Issues
# admissions/ LOS
Complications
Case volume/mix
Duration of Surgery
Equipment used
Tests ordered
Readmissions

7. Potential Administrative Data Sources
CMS
National Inpatient Census
Premier
ACS-NSQIP
Surgical Risk Formulae

8. What is NSQIP 30 day observational database
Trained and audited nurse evaluators
121 sites in the US (academic and community hospitals)

9. NSQIP Model vs Others

10. NSQIP Lap v Open
Kennedy et al. Ann Surg 2009;249: 596–601

11. NSQIP Lap v Open
Kennedy et al. Ann Surg 2009;249: 596–601

12. NSQIP Lap v Open
Kennedy et al. Ann Surg 2009;249: 596–601

13. NSQIP Lap v Open
Kennedy et al. Ann Surg 2009;249: 596–601

14. NSQIP Lap v Open
Kennedy et al. Ann Surg 2009;249: 596–601

15. NSQIP Lap v Open: Outcomes
Senagore et al. DCR : 183-6

16. NSQIP Lap v Open: ? cohorts
Senagore et al. DCR : 183-6

17. Departmental length of stay
/2000
n LOS n LOS n LOS
DRG 148
study team *
other CR teams
Laparoscopic *
DRG 149
study team †
other CR teams
Laparoscopic *
DRG 148 & 149
study team §
other CR teams
Laparoscopic *
* p<0.0001; † p=0.002; § p<0.001, Student’s t test
Delaney, Fazio, Senagore et al, Br J Surg, 2001

18. The Future ??

19. Conclusion Belief in a system approach Align stakeholder incentives
Understanding Cost/Quality Impacts
Report OUR Value Proposition