November 13, 2019
Breast reconstruction performed at hospitals in uncompetitive markets tends to cost less yet yields similar clinical outcomes as reconstruction at hospitals in more competitive markets, according to a study published recently in Annals of Surgery.
“This suggests that some of the economies of scale, access to capital, and care delivery efficiencies gained from increased market power following hospital mergers are passed onto payers and consumers as lower costs,” researchers wrote.
The retrospective study looked at costs, outcomes, and other factors for 42,411 women from the Nationwide Inpatient Sample who underwent immediate breast reconstruction after mastectomy between 2009 and 2011. All participants had private insurance.
For both nonfree flap reconstruction and free flap reconstruction, increased hospital market competition was associated with higher procedural markup, according to the study. For every 5 additional hospitals in a market, adjusted costs were 6.6% higher for free flap reconstruction and 5.1% higher for nonfree flap reconstruction.
Researchers found no links between inpatient complications or extended length of stay and hospital market competition.
“Decreasing market competition,” researchers concluded, “was associated with lower inpatient costs and equivocal clinical outcomes.”
Cerullo M, Sheckter CC, Canner JK, Rogers SO, Offodile AC 2nd. Is bigger better? The effect of hospital consolidation on index hospitalization costs and outcomes among privately insured recipients of immediate breast reconstruction [published online October 2019]. Ann Surg. 2019;270(4):681-691. doi: 10.1097/SLA.0000000000003481