On April 5 2012, Dr. Abhishek Chatterjee of the Dartmouth-Hitchcock Medical Center co-published a paper titled “Application of Total Care Time and Payment per Unit Time Model for Physician Reimbursement for Common General Surgery Operations” in the Journal of American College of Surgeons.
The paper compares the cost of a medical procedure to the amount of time the surgeon spends with the patient and calculates a “dollars per hour” valuation for five outpatient and four inpatient operations. Total care time was evaluated by summing the operative time, time spent in the hospital pre and post surgery, and time spent during office visits. The study assumed that each day spent in hospital required the surgeon to spend 30 minutes with the patient and that each subsequent visit to the surgeon’s office required additional 30 minutes of time.
The study focused on physician reimbursement by only taking into account money that was received by the physician. The study ignored extraneous medical fees such as costs of prescription medicine so that the cost of the surgery could be evaluated in terms of how much the surgeon considered his/her time was worth.
Under this model of cost evaluation, of the surgical procedures evaluated, gastric restrictive surgery with bypass was the most expensive, at $707.30 per hour. Partial Colectomy with anastomosis was the cheapest at $188.52 per hour. Both of these procedures were inpatient procedures, and while the study found that inpatient procedures had a higher variability in cost per hour, inpatient and outpatient costs per hour were similar on average.
With possible future cuts to Medicare and Medicaid, physician reimbursement has become a subject of intense scrutiny, and Dr. Chatterjee states, “increasing the objectivity in our reimbursement mechanisms is important in justifying a surgeon’s payment”.
Keeping objectivity in mind, the paper notes that the skill levels required for the two surgeries mentioned above are similar, and require a similar amount of additional study to master. The difference in cost per hour is suggested to be due to the higher amount of post and pre-operative testing required for a gastric restrictive surgery with bypass.
The paper argues that rising medical costs can be curtailed if physicians were paid based on their skill level and time spent, rather than on how many tests their patients have to undergo. This would reduce the incentive for physicians to send patients in for more tests
While this method of medical compensation would potentially lower medical costs and provide an objective scale to measure surgery costs, the paper does acknowledge that data from only nine surgeries were collected, and patients could be the victim of unexpected charges if complication during the surgery required the surgeon to spend more time with the patient. Furthermore, since post-operative care is included, there would be a new incentive for physicians to try and extend the amount of time patients spent in hospitals, thus straining a medical system in which hospital beds are already at a premium.
References
Abhishek Chatterjee, Stefan D. Holubar, Sean Figy, Lilian Chen, Shirley A. Montagne, Joseph M. Rosen, Joseph P. Desimone, Application of Total Care Time and Payment per Unit Time Model for Physician Reimbursement for Common General Surgery Operations, Journal of the American College of Surgeons, Available online 5 April 2012, ISSN 1072-7515, 10.1016/j.jamcollsurg.2012.02.003.
(http://www.sciencedirect.com/science/article/pii/S1072751512001391)