This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Roumm, A. R. Articles by Cohn, H. Search for Related Content PubMed PubMed Citation Articles by Roumm, A. R. Articles by Cohn, H. Social Bookmarking                   What's this?

Minimally Invasive: Minimally Reimbursed? An Examination of Six Laparoscopic Surgical Procedures

Departments of Health Policy

Laura Pizzi, PharmD, MPH

College of Graduate Studies, Thomas Jefferson University, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107 laura.pizzi{at}jefferson.edu

Neil I. Goldfarb

Departments of Health Policy

Herbert Cohn, MD

Surgery, Jefferson Medical College, Philadelphia, PA

It is generally believed that minimally invasive surgery (MIS) results in less postoperative pain, fewer complications, and shorter recovery periods compared with open procedures. Yet despite these benefits, the level of reimbursement assigned to the surgeon by United States health-care payers is often lower than that for open procedures. Furthermore, the cost of performing a MIS may be higher vs an open procedure because specialized equipment, increased surgical time, or both may be required. In this report, we examine the issue by comparing reimbursements for MIS with open procedures, summarizing the medical literature on MIS vs open surgical procedures, and offering recommendations for payers who establish reimbursement policies. The review is focused on six MIS procedures where outcomes data exist: laparoscopic cholecystectomy (lap chole), laparoscopic colectomy (LC), laparoscopic fundoplication (LF), laparoscopic hysterectomy (LH), laparoscopic ventral hernia repair (LVHR), and laparoscopic appendectomy (LA). Outcomes summarized were length of hospital stay (LOS), operating room time, operating room costs, complications, and return to work or normal activities. The level of scientific evidence was assigned to each study using predetermined criteria. A total of 112 articles were reviewed: 14 for lap chole, 26 for LC, 7 for LF, 19 for LH, 9 for LVHR, and 37 for LA. The data demonstrate that these procedures result in reduced hospital stay, reduced hospital costs, and faster return to work or normal activities. Yet, the operating room time and costs are frequently higher for MIS. These findings suggest that as both the outcomes value and level of operating room resources are greater, MIS warrants reimbursement that meets or exceeds that of open procedures.

Key Words: minimally invasive surgery • reimbursement • open procedures

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?