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Comparing Open Surgery to Laparoscopic - The Business Case -

Minimally Invasive Procedures. Comparing Open Surgery to Laparoscopic - The Business Case -. Kimberly Munro Aug 24, 2010 School Employees Health Care Board. DSL#10-0209. Worlds largest diversified healthcare company Corporate reputation Second Best in America **

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Comparing Open Surgery to Laparoscopic - The Business Case -

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  1. Minimally Invasive Procedures Comparing Open Surgery to Laparoscopic - The Business Case - Kimberly Munro Aug 24, 2010 School Employees Health Care Board DSL#10-0209

  2. Worlds largest diversified healthcare company • Corporate reputation Second Best in America ** • More than 200 separate operating companies in 57 countries • 53.3 billion dollars in sales • 44% Pharmaceuticals • 38% Medical Devices – Worlds Largest • 18% Consumer Products • Major provider of health benefits for • 122,000 employees world wide • 50,000 US based employees - 75,000 dependents

  3. Ethicon Endo-Surgery, Inc.

  4. Minimally Invasive Procedures: Defined Surgery performed through small incisions or the natural orifice using video cameras and specialized instrumentation This approach is often referred to as Laparoscopic

  5. Scope of Procedures Tomson (Solucient). New Procedure Volumes 2006

  6. Open Surgery versus MIP Medstat – MarketScan 3Q06-2Q07

  7. Clinical and Economic of MIP ROI is Immediate and Sustainable 2Minimally invasive: minimally reimbursed? An Examination of Six Laparoscopic Surgical Procedures. Roumm A, Pizzi L, Belsky A, et al. Surgical Innovation, Vol. 12, No 3 (September), 2005:261-287 2Fullum et al. 3Brill A, et al.

  8. MIP Impact on Hospital Length of Stay (LOS) Range of reduction in days when comparing MIP to open procedures Studies Reviewed 25 19 8 7 14 37 9 † 5 of the 37 studies for Appendectomy showed an increase ranging from 0.2 to 0.7 days Minimally invasive: minimally reimbursed? An Examination of Six Laparoscopic Surgical Procedures. Roumm A, Pizzi L, Belsky A, et al. Surgical Innovation, Vol. 12, No 3 (September), 2005:261-287

  9. MIP Impact on Return to Work (RTW) Range of reduction in days when comparing MIP to open procedures 2 4 1 4 8 10 1 Studies Reviewed † 2 of the 10 studies for Appendectomy showed no reduction Minimally invasive: minimally reimbursed? An Examination of Six Laparoscopic Surgical Procedures. Roumm A, Pizzi L, Belsky A, et al. Surgical Innovation, Vol. 12, No 3 (September), 2005:261-287

  10. MIP Impact on Return to Normal Activity (RTNA) Range of reduction in days when comparing MIP to open procedures 2 1 1 2 14 1 Studies Reviewed † 2 of the 14 studies for Appendectomy showed an increase ranging from 1-6 days Minimally invasive: minimally reimbursed? An Examination of Six Laparoscopic Surgical Procedures. Roumm A, Pizzi L, Belsky A, et al. Surgical Innovation, Vol. 12, No 3 (September), 2005:261-287

  11. MIP Reduces Risk of Complications 1p<.05 2When comparing open versus laparoscopic approached and controlling for the following factors: age, gender, type of insurance, case mix index and complexity of disease. 3 An infection in the blood LH = Laparoscopic Hysterectomy VH = Vaginal Hysterectomy TAH = Total Abdominal Hysterectomy †Fullum et al. Comparison of the clinical and economic outcomes between open and minimally invasive appendectomy and colectomy: evidence from a large commercial payer database. Surg Endosc 2009. ‡Warren L et al. Open abdominal versus laparoscopic and vaginal hysterectomy: analysis of a large United States payer measuring quality and cost of care. Journal of Minimally Invasive Gynecology, Vol 16, No 5, September/October 2009

  12. Minimally Invasive Surgery Significantly Reduces Nosocomial Infections The CDC estimates that 2 Million patients acquire nosocomial infections each year, resulting in over $4.5 Billion Dollars in cost to the US healthcare system. 1 Laparoscopic surgery reduced the risk of nosocomial infections by more than 50 percent when compared to open surgery, across hysterectomies, cholecystectomies (gallbladder) and appendectomies Gallbladder—66% reduction Hysterectomy—52% reduction Appendectomies—Lower, but not statistically significant Reduction In Odds Of Acquiring Infection By Type: Respiratory Tract—80% reduction Bloodstream—69% reduction Wound—59% reduction Urinary Tract—39% reduction Others—48% reduction Hospital re-admissions associated with infection—65% reduction 2 Sources: 1 Centers for Disease Control Prevention. Nosocomial infection update. Emerging Infectious Diseases. 1998; 43: 416-420 2 “The effects of Laparoscopic Cholecystectomy, Appendectomy, and Hysterectomy on nosocomial infection risks.” Andrew Brill, MD, FACS, KathakaliGhosh, MS, Candace L. Gunnarsson, Ed.D., John Rizzo, PhD, Terrance Fullum, MD, FACS, Craig A. Maxey, MBA, Stephen E. Brossette, MD, PhD, Surgical Endoscopy, February, 2008 DSL#08-0168 Minimally Invasive Surgery Overview

  13. The Effects of Nosocomial Infections (NI) on Cost of Care to Payer 2 Statistically significant at the 1% level, two tailed test Gunnarsson C et al. The effects of laparoscopic surgery and nosocomialinfections on the cost of care. Value in Health 2008 July; Vol 12, Issue 1

  14. Short Term Disability Guidelines

  15. MIP Impact on Overall Costs 1 Risk Adjusted 2p<.05 3 p<.001 4 p<.01 †Fullum et al. Comparison of the clinical and economic outcomes between open and minimally invasive appendectomy and colectomy: evidence from a large commercial payer database. SurgEndosc 2009. ‡Gunnarsson C et al. The effects of laparoscopic surgery and nosocomial infections on the cost of care. Value in Health 2008 July; Vol 12, Issue 1

  16. Comparing Expenditures by Inpatient & Outpatient Care Setting Reduction in spending of $2294 per procedure1, 2 † Hysterectomy is the 5th most common surgical procedure for females.†† 1 Adjusted for surgery type, patient age at index date, gender, Charlson Morbidity Index, geographic region, and medical degree specialty 2p<.05 † Warren L et al. Open abdominal versus laparoscopic and vaginal hysterectomy: analysis of a large United States payer measuring quality and cost of care. Journal of Minimally Invasive Gynecology, Vol 16, No 5, September/October 2009 ††HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2007

  17. Realizing the Value of Minimally Invasive Surgery An Employer’s Perspective Colorado Spring School District 11

  18. D11 - Background • Core K-12 district • 30,000 students • 60 schools • Self-funded medical plan: • 2,600 employees; 6,400 lives • Medical budget is $28 million • 70% women and high incidence of chronic diseases

  19. D11 – Copayment Incentives

  20. D11 – Two-Year Outcomes Two-year savings of $1 Million “Every extra dollar spent on healthcare is a dollar that doesn’t get to the classroom.” - Ken Detweiler

  21. Questions?

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