@article{2a0b67ac2f3943eebbaccaaa9c2c7427,
title = "Pay for Obesity? Pay-for-Performance Metrics Neglect Increased Complication Rates and Cost for Obese Patients",
abstract = "Background: 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. Methods: 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. Results: 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). Conclusion: 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.",
keywords = "Appendectomy, Cholecystectomy, Cost, Obesity, Pay for performance",
author = "Kenzo Hirose and Shore, {Andrew D.} and Wick, {Elizabeth C.} and Weiner, {Jonathan P.} and Makary, {Martin A.}",
note = "Funding Information: Acknowledgments The dataset used in this current study was originally created for a research project on patterns of obesity care within selected Blue Cross and Blue Shield plans. The original study was funded by unrestricted research grants from Ethicon Endo-Surgery, Inc. (a Johnson & Johnson company); Pfizer, Inc.; and GlaxoSmithKline. The data and in-kind database development support and guidance were provided by the Blue Cross and Blue Shield Obesity Care Collaborative, which is comprised of the following organizations affiliated with the Blue Cross and Blue Shield (BCBS) Health Services Research Alliance: BCBS Association, BCBS of Tennessee, BCBS of Hawaii, BCBS of Michigan, BCBS of North Carolina, Highmark, Inc. (of Pennsylvania), Independence Blue Cross (of Pennsylvania), Wellmark BCBS of Iowa, and Wellmark BCBS of South Dakota. Funding Information: Funding Sources This research was conducted by the Johns Hopkins University DEcIDE Center under contract to the Agency for Healthcare Research and Quality (Contract no. HHSA290-05-0034-1-TO2-WA2, Project I.D. no. 20-EHC-2), Rockville, MD. The dataset used in this current study was originally created for a different research project on patterns of obesity care within selected Blue Cross and Blue Shield plans. The previous research project (but not the current study) was funded by unrestricted research grants from Ethicon Endo-Surgery, Inc. (a Johnson & Johnson company); Pfizer, Inc.; and GlaxoSmithKline. The data and database development support and guidance were provided by the Blue Cross and Blue Shield Association, Blue Cross and Blue Shield of Tennessee, Blue Cross and Blue Shield of Hawaii, Blue Cross and Blue Shield of Michigan, Blue Cross and Blue Shield of North Carolina, Highmark, Inc. (of Pennsylvania), Independence Blue Cross (of Pennsylvania), Wellmark Blue Cross and Blue Shield of Iowa, and Wellmark Blue Cross and Blue Shield of South Dakota. All listed authors contributed to the design, analysis, or writing of this study and none has conflicts of interest. The authors of this abstract are responsible for its content. No statement may be construed as the official position of the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. Additional funding was provided by the Mr. and Mrs. Chad and Nissa Richison Foundation. Copyright: Copyright 2012 Elsevier B.V., All rights reserved.",
year = "2011",
month = jul,
doi = "10.1007/s11605-011-1529-3",
language = "English (US)",
volume = "15",
pages = "1128--1135",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "7",
}