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New Studies Examine Adverse Outcomes Associated With Obesity and More Applicable Measures of Obesity

New Medicare and Medicaid payment policies are intended to reward physicians for positive patient outcomes while cutting costs. New research from the Johns Hopkins University School of Medicine shows such policies may provide financial incentives for doctors to discriminate against patients.

The premise behind pay-for-performance policies is to financially reward hospitals and doctors for good outcomes and punish for poor patient outcomes by adjusting reimbursement by one to two percent if an infection occurs within 30 days of surgery. According to Martin Makary, MD, MPH, surgeon and associate professor of public health at the Johns Hopkins School of Medicine, such payment structures fail to account for patient factors that are out of the control of doctors yet influence outcomes, the most common being obesity, which can double a patient's chance of infection.

Studying national insurance claims of 36,483 patients who had undergone one of two common general surgical procedures, Dr. Makary, senior author of the study, found that obese patients undergoing appendectomy were 25 percent more likely to experience complications, and patients undergoing cholecystetomy were 7 percent more likely to have complications. In addition, Makary found that the cost of providing such care was higher for obese patients: the median total inpatient costs for obese patients after a basic gallbladder removal were $2,978 higher and $1,600 higher for appendectomy.

Because obesity rates are higher in minority populations - black women have a 50 percent incidence of being overweight compared to 18 percent for white men - Dr. Makary expressed concern for the discrimination implications under such payment structures. "What sounds good in theory turns out in reality to punish doctors who take care of more high-risk patients, and actually financially incentivizes discrimination," said Dr. Makary.

Dr. Makary points out that standardized outcomes accounting for patient factors would eliminate the unintended incentives to discriminate. The National Surgical Quality Improvement Program (NSQIP) is a doctor-initiated program that has developed outcome measures.

SOURCE Digestive Disease Week