Medicare enrollees are significantly less likely than others to undergo minimally invasive surgical procedures, suggesting they lose out on chances to receive care with better outcomes and likely shorter hospital stays.
That’s the conclusion of researchers at Johns Hopkins University, who examined the records of more than 200,000 Medicare patients culled from the 2014 Provider Analysis and Review Inpatient Limited Data Set. The patients underwent seven common surgical procedures: Gallbladder removal, bariatric surgery, colectomy, hysterectomy, and repairs of inguinal, thoracic and ventral hernias. The findings were published recently in the journal Surgical Endoscopy.
Of this group, about 102,000 patients underwent conventional surgery, while another 131,000 underwent minimally invasive surgery. Readmission rates and time spent in the hospital were lower for 6 of the 7 minimally invasive procedures. And costs were lower for four of the surgeries when they’re minimally invasive, ranging from about $3,000 to $4,800 less per procedure. Medicare also reimbursed at lower level for three of the surgeries, ranging from about $840 to $940 less per procedure.
“This study shows there is an opportunity for Medicare and other payers to spend healthcare dollars more wisely so that they reward high-value care over low-value care” said study author Martin Makary, M.D., a professor of surgery at the Johns Hopkins University School of Medicine, in an announcement about the findings.
Other experts have suggested physician bias may play a role in who receives a minimally invasive procedure and who does not. Too many providers may rely on their individual judgment and skill sets to make a decision, and that can lead to variations in care. Instead, experts recommend that provides make such decisions based on data and outcomes specifically.
However, not all minimally invasive surgeries are more cut-and-dried than traditional procedures. Data published in 2015 indicated that minimally invasive surgeries conducted by robots have led to significant levels of complications. The robots themselves have also malfunctioned thousands of times. Injury rates were particularly high for cardiothoracic and head and neck surgery. And robotic surgery for colonoscopies conferred no benefit compared to laparoscopic surgery, but costs significantly more.