The following is a summary of the “Neighborhood deprivation and Medicare expenditures for common surgical procedures” published in the November 2022 issue of Surgery by Bonner et al.
Clinical risk variables were taken into account in the Center for Medicare and Medicaid Services’ valuation-based reimbursements for inpatient surgical hospitalizations, but not social risk factors. Although research had indicated that social risk was linked to poorer surgical patient outcomes, it was uncertain if social risk variables impact Medicare payments for inpatient surgical episodes.
Review of Medicare recipients who underwent an appendectomy, colectomy, hernia repair, or cholecystectomy between 2014 and 2018 and were aged 65 to 99. The area Deprivation Index is used to quantify neighborhood deprivation in the recipient census tract. By beneficiary neighborhood deprivation, they assessed Medicare payments for an episode of surgical treatment that included the index hospitalization, physician fees, post-acute care, and readmission.
There were 809,059 patients (women made up 56.0% of the population), with an average (SD) age of 75.7 years. There were a total of 145,351 beneficiaries who lived in the least depressed areas and 134,188 beneficiaries who resided in the most depressed areas. After risk adjustment for clinical and institutional characteristics, beneficiaries from the poorest neighborhoods spent more overall on each surgical episode ($2,654 more than beneficiaries from the wealthiest communities). These discrepancies were partially caused by beneficiaries residing in the most impoverished areas having higher rates of readmissions (12.9% vs. 10.8%, P< 0.001) and post-acute care (67.8% vs. 61.2%, P< 0.001).
According to the findings; surgical cohorts may require value-based payment models that take social risk adjustment into account. Additionally, initiatives aimed at helping underprivileged populations may align with raising surgical quality.