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'Destination care' lowers costs, improves satisfaction in bariatric surgery
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LAS VEGAS — A national destination care program for bariatric surgery can be both safe and effective, with an analysis suggesting the model is associated with higher satisfaction metrics and similar 30-day clinical outcomes for complications and readmissions when compared with non-destination care programs, according to findings presented at ObesityWeek.
Providers have legitimate concerns about corporate-sponsored destination care programs, which are increasingly being used to manage employee costs and ensure quality, Mark Dudash, MD, a general surgery resident with Geisinger Medical Center in Danville, Pennsylvania, and colleagues wrote in an abstract. However, an analysis suggests that a national destination care program can be safe and effective and associated with provider savings.
“To become a destination health care center, you need to meet certain characteristics,” Dudash said during a presentation. “You have to have strong quality indicators, a track record of evidence-based, integrated care delivery and willingness to take on the risk of participating in bundled care pricing.”
Becoming a destination care center can also offer benefits, Dudash said. Meeting the characteristics improves care for all patients, attracts new business and helps reinforce adherence to protocols and best practice of care. The Geisinger Medical Center bariatric destination care program is an employer-driven benefit, outside of a regular insurance benefit, Dudash said.
“It is an episodic bundle that covers all procedure costs related to that care, which is prospectively determined and fixed,” Dudash said. “We contracted with the largest employer in the United States, with more than 1 million employees and families covered. The benefit for bariatric surgery initially was a BMI of at least 40 kg/m² with type 2 diabetes, but it has subsequently been liberalized to meet NIH criteria.”
In a retrospective database review, Dudash and colleagues analyzed data from 63 destination care patients who traveled for an initial bariatric surgery procedure as part of a workplace health care benefit between December 2016 and July 2018 (mean age, 47 years; 73% women; mean BMI, 48.3 kg/m²; 40 Roux-en-Y gastric bypass; 23 sleeve gastrectomy). The researchers assessed 30-day outcomes for both destination care and non-destination care patients (n = 632; mean age, 43 years; 82.4% women; mean BMI, 46.1 kg/m²) who underwent bariatric surgery at the same center, and calculated 6-month total body weight loss.
Researchers found that patients traveled from 20 states, primarily in the mid-Atlantic and southeastern U.S. The 6-month total body weight loss was similar for destination and non-destination patients in both groups who underwent Roux-en-Y gastric bypass (26.5% vs. 28.2%, respectively) and sleeve gastrectomy (22.9% vs. 25.6%, respectively). Destination patients were older and had a higher BMI vs. non-destination patients; however, there were no between-group differences in any clinical 30-day outcomes, including complications, readmission and reoperation. Satisfaction outcomes, as measured by Press Ganey scores, favored the destination group, who rated higher satisfaction for access, care provider, personal issues and likelihood to recommend metrics vs. non-destination patients. Researchers also found that, 9 months after surgery, per member per month medical costs fell by 54% and pharmaceutical costs decreased by 73% for those in the destination care group, Dudash said.
Dudash noted that the study reflects a single-center experience, examining only 30-day perioperative outcomes and 6-month total body weight loss. He said that success requires a “significant, full-time equivalent investment” and a highly coordinated work effort between providers, patients and payers. – by Regina Schaffer
Reference:
Vacharathit V, et al. A192. Presented at: ObesityWeek 2019; Nov. 3-7, 2019; Las Vegas.
Disclosure: Dudash reports no relevant financial disclosures.