Association between Hospital Market Concentration and Costs of Laryngectomy

Research output: Contribution to journalArticle

Abstract

Importance: High-volume hospital care for laryngectomy has been shown to be associated with reduced morbidity, mortality, and costs; however, most hospitals in the United States do not perform high volumes of laryngectomies. The influence of market competition on charges and costs for such patients has not been defined. Objective: To examine the association between regional hospital market concentration, hospital charges, and costs for laryngectomy. Design, Setting, and Participants: The Nationwide Inpatient Sample was used to identify 34193 patients who underwent laryngectomy for a malignant laryngeal or hypopharyngeal neoplasm from January 1, 2003, to December 31, 2011. Hospital laryngectomy volume was modeled as a categorical variable. Hospital market concentration was evaluated using a variable-radius Herfindahl-Hirschman Index from the 2003, 2006, and 2009 Hospital Market Structure Files. Statistical analysis was performed from May 19 to August 15, 2018. Main Outcomes and Measures: Multivariable generalized linear regression was used to evaluate associations between market concentration and total charges and costs for laryngectomy. Results: Among the 34193 patients (19.3% female and 80.7% male; mean age, 62.7 years [range, 20.0-96.0 years]), 69.2% of procedures were performed at hospitals in highly concentrated (noncompetitive) markets and 26.2% were performed at hospitals in unconcentrated (highly competitive) markets. Most high-volume hospitals (68.0%) were located in highly concentrated markets, followed by unconcentrated markets (32.0%). Market share and volume were not associated with significant differences in total charges. Unconcentrated markets were associated with 28% higher costs (95% CI, 8%-53%) relative to moderately concentrated and highly concentrated markets. High-volume hospitals were associated with 22% lower costs (95% CI, -36% to -5%). Conclusions and Relevance: Competition among hospitals is associated with increased costs of care for laryngectomy. High-volume hospital care is associated with lower costs of care. These data suggest that hospital market consolidation of laryngectomy at centers able to meet minimum volume thresholds may improve health care value..

Original languageEnglish (US)
JournalJAMA Otolaryngology - Head and Neck Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Laryngectomy
High-Volume Hospitals
Costs and Cost Analysis
Hypopharyngeal Neoplasms
Hospital Charges
Laryngeal Neoplasms
Hospital Costs
Inpatients
Linear Models
Outcome Assessment (Health Care)
Morbidity
Delivery of Health Care
Mortality

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

@article{6daf8d85947b40c08415266b51555dee,
title = "Association between Hospital Market Concentration and Costs of Laryngectomy",
abstract = "Importance: High-volume hospital care for laryngectomy has been shown to be associated with reduced morbidity, mortality, and costs; however, most hospitals in the United States do not perform high volumes of laryngectomies. The influence of market competition on charges and costs for such patients has not been defined. Objective: To examine the association between regional hospital market concentration, hospital charges, and costs for laryngectomy. Design, Setting, and Participants: The Nationwide Inpatient Sample was used to identify 34193 patients who underwent laryngectomy for a malignant laryngeal or hypopharyngeal neoplasm from January 1, 2003, to December 31, 2011. Hospital laryngectomy volume was modeled as a categorical variable. Hospital market concentration was evaluated using a variable-radius Herfindahl-Hirschman Index from the 2003, 2006, and 2009 Hospital Market Structure Files. Statistical analysis was performed from May 19 to August 15, 2018. Main Outcomes and Measures: Multivariable generalized linear regression was used to evaluate associations between market concentration and total charges and costs for laryngectomy. Results: Among the 34193 patients (19.3{\%} female and 80.7{\%} male; mean age, 62.7 years [range, 20.0-96.0 years]), 69.2{\%} of procedures were performed at hospitals in highly concentrated (noncompetitive) markets and 26.2{\%} were performed at hospitals in unconcentrated (highly competitive) markets. Most high-volume hospitals (68.0{\%}) were located in highly concentrated markets, followed by unconcentrated markets (32.0{\%}). Market share and volume were not associated with significant differences in total charges. Unconcentrated markets were associated with 28{\%} higher costs (95{\%} CI, 8{\%}-53{\%}) relative to moderately concentrated and highly concentrated markets. High-volume hospitals were associated with 22{\%} lower costs (95{\%} CI, -36{\%} to -5{\%}). Conclusions and Relevance: Competition among hospitals is associated with increased costs of care for laryngectomy. High-volume hospital care is associated with lower costs of care. These data suggest that hospital market consolidation of laryngectomy at centers able to meet minimum volume thresholds may improve health care value..",
author = "Christine Gourin and Peter Vosler and Rajarsi Mandal and Karen Pitman and Carole Fakhry and Eisele, {David W} and Kevin Frick and Austin, {John Matthew}",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamaoto.2019.2303",
language = "English (US)",
journal = "Archives of Otolaryngology",
issn = "2168-6181",
publisher = "American Medical Association",

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TY - JOUR

T1 - Association between Hospital Market Concentration and Costs of Laryngectomy

AU - Gourin, Christine

AU - Vosler, Peter

AU - Mandal, Rajarsi

AU - Pitman, Karen

AU - Fakhry, Carole

AU - Eisele, David W

AU - Frick, Kevin

AU - Austin, John Matthew

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: High-volume hospital care for laryngectomy has been shown to be associated with reduced morbidity, mortality, and costs; however, most hospitals in the United States do not perform high volumes of laryngectomies. The influence of market competition on charges and costs for such patients has not been defined. Objective: To examine the association between regional hospital market concentration, hospital charges, and costs for laryngectomy. Design, Setting, and Participants: The Nationwide Inpatient Sample was used to identify 34193 patients who underwent laryngectomy for a malignant laryngeal or hypopharyngeal neoplasm from January 1, 2003, to December 31, 2011. Hospital laryngectomy volume was modeled as a categorical variable. Hospital market concentration was evaluated using a variable-radius Herfindahl-Hirschman Index from the 2003, 2006, and 2009 Hospital Market Structure Files. Statistical analysis was performed from May 19 to August 15, 2018. Main Outcomes and Measures: Multivariable generalized linear regression was used to evaluate associations between market concentration and total charges and costs for laryngectomy. Results: Among the 34193 patients (19.3% female and 80.7% male; mean age, 62.7 years [range, 20.0-96.0 years]), 69.2% of procedures were performed at hospitals in highly concentrated (noncompetitive) markets and 26.2% were performed at hospitals in unconcentrated (highly competitive) markets. Most high-volume hospitals (68.0%) were located in highly concentrated markets, followed by unconcentrated markets (32.0%). Market share and volume were not associated with significant differences in total charges. Unconcentrated markets were associated with 28% higher costs (95% CI, 8%-53%) relative to moderately concentrated and highly concentrated markets. High-volume hospitals were associated with 22% lower costs (95% CI, -36% to -5%). Conclusions and Relevance: Competition among hospitals is associated with increased costs of care for laryngectomy. High-volume hospital care is associated with lower costs of care. These data suggest that hospital market consolidation of laryngectomy at centers able to meet minimum volume thresholds may improve health care value..

AB - Importance: High-volume hospital care for laryngectomy has been shown to be associated with reduced morbidity, mortality, and costs; however, most hospitals in the United States do not perform high volumes of laryngectomies. The influence of market competition on charges and costs for such patients has not been defined. Objective: To examine the association between regional hospital market concentration, hospital charges, and costs for laryngectomy. Design, Setting, and Participants: The Nationwide Inpatient Sample was used to identify 34193 patients who underwent laryngectomy for a malignant laryngeal or hypopharyngeal neoplasm from January 1, 2003, to December 31, 2011. Hospital laryngectomy volume was modeled as a categorical variable. Hospital market concentration was evaluated using a variable-radius Herfindahl-Hirschman Index from the 2003, 2006, and 2009 Hospital Market Structure Files. Statistical analysis was performed from May 19 to August 15, 2018. Main Outcomes and Measures: Multivariable generalized linear regression was used to evaluate associations between market concentration and total charges and costs for laryngectomy. Results: Among the 34193 patients (19.3% female and 80.7% male; mean age, 62.7 years [range, 20.0-96.0 years]), 69.2% of procedures were performed at hospitals in highly concentrated (noncompetitive) markets and 26.2% were performed at hospitals in unconcentrated (highly competitive) markets. Most high-volume hospitals (68.0%) were located in highly concentrated markets, followed by unconcentrated markets (32.0%). Market share and volume were not associated with significant differences in total charges. Unconcentrated markets were associated with 28% higher costs (95% CI, 8%-53%) relative to moderately concentrated and highly concentrated markets. High-volume hospitals were associated with 22% lower costs (95% CI, -36% to -5%). Conclusions and Relevance: Competition among hospitals is associated with increased costs of care for laryngectomy. High-volume hospital care is associated with lower costs of care. These data suggest that hospital market consolidation of laryngectomy at centers able to meet minimum volume thresholds may improve health care value..

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