Cost management strategies for carotid endarterectomy

Background: We developed a model for capitation and global pricing for carotid endarterectomy. Methods: A care algorithm for diagnosis, perioperative management, and postoperative care using cost data was developed. Perioperative care charges were extrapolated from a 1-year experience and applied to...

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Bibliographic Details
Published in:The American journal of surgery 1998-08, Vol.176 (2), p.188-192
Main Authors: Ricotta, John J, Hargadon, Terry, O’Brien-Irr, Mollie
Format: Article
Language:English
Subjects:
Age Factors
Aged
Algorithms
Anesthesia - economics
Angiography
Angiography - economics
Asymptomatic
Biological and medical sciences
Capitation
Capitation Fee
Carotid Stenosis - diagnosis
Confidence intervals
Cost benefit analysis
Cost control
Costs and Cost Analysis
Diagnostic tests
Drug Therapy - economics
Endarterectomy, Carotid - economics
Fees & charges
Fees, Medical
Follow-Up Studies
Health care expenditures
Hospitalization - economics
Hospitals
Humans
Ischemia
Magnetic Resonance Angiography - economics
Medical imaging
Medical sciences
Middle Aged
Mortality
Neuroimaging
Operating Rooms - economics
Patients
Perioperative care
Physicians
Postoperative period
Pricing
Reimbursement
Reoperation
Surgeons
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Ultrasonography, Doppler, Duplex - economics
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Background: We developed a model for capitation and global pricing for carotid endarterectomy. Methods: A care algorithm for diagnosis, perioperative management, and postoperative care using cost data was developed. Perioperative care charges were extrapolated from a 1-year experience and applied to models to determine pricing for a 1-year global fee and a 5-year capitated contract. Results: Global pricing was estimated at $12,071 per patient while a capitated price for 5-year care was $17,175. Based on the age mix of the population, a per member, per month cost could be calculated assuming a frequency of 414 procedures per 100,000 patients over age 65 and 31 procedures per 100,000 patients under 65. Sources of costs were extensive preoperative diagnostic testing, particularly angiography, brain imaging, and cardiac evaluation. Conclusions: Global pricing and capitation are both feasible for carotid endarterectomy. Each approach has unique risks and benefits.
ISSN:0002-9610
1879-1883
DOI:10.1016/S0002-9610(98)00128-7