Use of medical consultations for surgical patients, especially those without complications, varied widely across hospitals, found in a study of Medicare beneficiaries undergoing surgery for 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 hospital medical consultations for surgical patients, 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.
"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 complications - 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 patients has transformed substantially, from consultant to comanager."
"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.