Medical consultations for surgical patients examined amid payment changes

August 4, 2014, The JAMA Network Journals

The use of medical consultations for surgical patients varied widely across hospitals, especially among patients without complications, in a study of Medicare beneficiaries undergoing colectomy (to remove all or part of their colon) or total hip replacement (THR).

Internists and medical subspecialists are frequently called on to assess surgical patients and to help manage their care. As payers move toward bundled payments, hospitals need to better understand variations in practice and resources used during patient care.

The authors examined medical consultations for , the factors that influenced their use and practice variation across hospitals. The study used Medicare claims data for 91,684 patients who underwent colectomy at 930 hospitals and 339,319 patients who had THR at 1,589 hospitals from 2007 through 2010.

More than half of the patients undergoing colectomy or THR (69 percent and 63 percent, respectively) had at least one medical consultation while hospitalized. The median number of consult visits was nine for colectomy patients and three for THR. Hospital variation in the use of medical consultations was greater for colectomy patients without complications (47 percent – 79 percent) vs. among those with complications (90 percent – 95 percent). Hospital variation was similar for THR (36 percent – 87 percent among patients without complications vs. 89 percent – 94 percent among those with complications). Nonteaching and for-profit hospitals had greater use of medical consultations for colectomy patients and larger hospitals had greater use of consultations for THR patients.

"Medical consultations are a common component of episodes of inpatient surgical care. Our findings of wide variation in medical consultation use – particularly among patients without – suggest that understanding when medical consultations provide value will be important as hospitals seek to increase their efficiency under bundled payments."

In a related commentary, Gulshan Sharma, M.D., M.P.H., of the University of Texas Medical Branch, Galveston, writes: "Over the past 20 years, the role of the medical consultant for surgical has transformed substantially, from consultant to comanager." Lena M. Chen, M.D., M.S., of the University of Michigan, Ann Arbor, and colleagues wrote in their JAMA Internal Medicine paper.

"While medical consultation has many anticipated benefits, there are downsides as well, including the potential for confusion when multiple opinions are sought; the challenge of decision making when multiple decision makers are included; lack of ownership when problem arises; and the costs associated with soliciting additional input," he continues.

"There is no one fit for all. Decisions on routine use of medical consultation for highly reimbursed procedures should be driven by institutional data on quality and cost," Sharma concludes.

Explore further: Orthopedic surgery generally safe for patients age 80 and older

More information: JAMA Intern Med. Published online August 4, 2014. DOI: 10.1001/jamainternmed.2014.3376
JAMA Intern Med. Published online August 4, 2014. DOI: 10.1001/jamainternmed.2014.1499

Related Stories

Orthopedic surgery generally safe for patients age 80 and older

July 17, 2014
Over the past decade, a greater number of patients, age 80 and older, are having elective orthopaedic surgery. A new study appearing in the Journal of Bone and Joint Surgery (JBJS) found that these surgeries are generally ...

Increase in consultations for Medicare patients before cataract surgery

December 23, 2013
Preoperative consultations before cataract surgery became more common for Medicare patients despite no clear guidelines about when to require such a service, hinting at unnecessary use of health care resources, according ...

Black surgery patients in US more likely to receive unnecessary, and dangerous, blood transfusions

May 9, 2014
Black patients in the U.S. are more likely to receive perioperative red blood cell (RBC) transfusions for two of three frequently performed surgical procedures, posing a risk for favorable outcomes, a study by University ...

Total hip replacement surgery safe for nonagenarian patients

March 11, 2014
As more Americans are living well into their 90s, the number of nonagenarian total hip replacement (THR) candidates continues to increase. In the study, "Total Hip Arthroplasty Proves Safe for Nonagenarian Patients," presented ...

Surgical site infections associated with excess costs at Veterans Affairs hospitals

May 21, 2014
Surgical site infections (SSIs) acquired by patients in Veterans Affairs (VA) hospitals are associated with costs nearly twice as high compared to patients who do not have this complication. The greatest SSI-related costs ...

More lumbar Sx complications at teaching hospitals

March 12, 2014
(HealthDay)—Patients undergoing lumbar spine surgery at teaching hospitals incur longer hospitalizations and have more postoperative complications compared to those treated at nonteaching hospitals, according to a study ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.