Financial impact of improving patient care setting selection after bariatric surgery

Abstract

Background: Potentially avoidable emergency department (ED) visits are a significant source of excess healthcare spending. Despite improvement in postoperative readmissions, 20% of bariatric surgery patients use the ED postoperatively. Many of these visits may be appropriately managed in lower-acuity centers.

Objective: We sought to evaluate the economic impact of shifting potentially avoidable ED visits after bariatric surgery to lower-acuity centers.

Setting: Statewide quality improvement collaborative.

Methods: We performed an observational study of patients who underwent bariatric surgery between 2011 and 2017 using a linked data registry, including clinical data from a large-quality improvement collaborative and payment data from a statewide value collaborative. Postoperative ED visits and readmission rates were determined. Ninety-day ED and urgent care center (UCC) visit claims were matched to a clinical registry. Price-standardized payments for UCC and ED visits without admission were compared.

Results: Among the 36,071 patients who underwent bariatric surgery, 8.4% presented to the ED postoperatively. Approximately 50% of these visits resulted in readmission. Three hundred eighty-eight ED visits without readmission (i.e., potentially avoidable ED visits) and 110 UCC encounters with claims data were identified. Triaging a potentially avoidable ED visit to an UCC would generate a savings of $4238 per patient, reducing spending in this cohort by $1.6 million.

Conclusion: Shifting potentially avoidable ED visits after bariatric surgery could result in significant cost savings. Efforts to improve patients' selection of healthcare setting and increase utilization of lower-acuity centers may serve as a template for appropriately meeting the needs of patients and containing spending after bariatric surgery.

Keywords: Bariatric surgery; Cost containment; Emergency department visit; Health policy; Nonurgent ED visit; Urgent care center.