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Rural Surgery Practice Patterns “What Rural Surgeons Really Do”

Rural Surgery Practice Patterns “What Rural Surgeons Really Do”. Robert P. Sticca, MD, FACS Joel Harris, MD, MPH Department of Surgery University of North Dakota School of Medicine and Health Sciences. Background. 55 million rural Americans

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Rural Surgery Practice Patterns “What Rural Surgeons Really Do”

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  1. Rural Surgery Practice Patterns“What Rural Surgeons Really Do” Robert P. Sticca, MD, FACS Joel Harris, MD, MPH Department of Surgery University of North Dakota School of Medicine and Health Sciences

  2. Background 55 million rural Americans approximately 20% of population depending on definition 17,243 general surgeons in US 2005 approximately 10-20% of general surgeons practice in rural areas Urban 6.53/100,000 population Large Rural 7.71/100,000 population Small or Isolated Rural Areas 4.67/100,000 population Shively EH. Am J Surgery Aug 2005; Thompson MJ. Arch Surg Jan 2005 Heneghan SJ. J Am Coll Surg Nov 2005

  3. Rural Versus Urban Inpatient Case-Mix Across Inpatient Procedures that Are Typically a Focus of General Surgery Training VanBibber, M. J Am Coll Surg, 2006

  4. Rural vs Urban Differences Ritchie WP. AnnSurg. 230(4); 533. 1999

  5. Rural vs Urban Casemix Heneghan SJ et al, JACS :2005 ; 732-36

  6. University of North Dakota Study North and South Dakota medical boards Licensed general surgeons Rural practice location (RUCA) Each contacted – Lifestyle and Practice Pattern Survey CPT Data Office and OR procedure codes January 1, 2006 – December 31,2006 All included – inpatient, outpatient, office, outreach

  7. RUCA Codes Rural Urban Commuting Area (RUCA) codes Developed by University of Washington Rural Health Research Institute and Department of Agriculture Every zip code assigned status based upon: Population and commuter traffic flow Large Rural (10,000-49,999) Small Rural (2,500-9,999) Isolated (<2,500) http://depts.washington.edu/uwruca

  8. Eligible Rural General Surgeons by RUCA Code North Dakota (n=23) + South Dakota (n=36) = 59

  9. Response Flow Chart n=59 Rural Surgeons (ND/SD medical board databases) 3 Retired or Relocated 56 Contacted 4 <30 procedures/year 4 Refused Participation 48 Included in Study Completed Lifestyle Survey

  10. Inclusion Criteria Surgery Practice In Practice at location > 12 months Volume > 30 cases/year Case records available

  11. Response Flow Chart n=48 Active Rural North and South Dakota General Surgeons n=4 No access to data n=3 Refused Participation n=41 (85%) Obtained Data n=31 (76%) Large Rural Surgeons n=10 (24%) Small Rural Surgeons

  12. Results Procedures – 40,827 (n = 39) General Surgery – 85.7% Specialty Surgery – 12.6% Procedures/Surgeon (mean) - 1047 Greatest Volume – Endoscopy – 39.5%

  13. General Surgery Procedures

  14. Specialty Surgery Procedures

  15. *Based on two sided chi-square p<0.001

  16. General surgery caseload differences between large and small rural general surgeons *Based on two sided chi-square

  17. Percentage of surgical specialty procedures performed by rural general surgeons *Based on two sided chi-square

  18. Surgical subspecialty caseload differences between large and small rural surgeons *Based on two sided chi-square

  19. Literature Comparison

  20. Conclusions Rural surgeons perform more surgical procedures than urban surgeons Casemix is heavily weighted towards endoscopy and skin/soft tissue Specialty procedures are performed by rural surgeons but make up a minority of cases performed Previous data on rural surgery practice patterns did not include full spectrum of rural practice

  21. Statistical Analysis Clinical Classification Software (CCS) Developed by Healthcare Cost and Utilization Project (HCUP) Federal-State-Industry partnership sponsored by Agency for Healthcare Research and Policy 244 mutually exclusive categories: Current Procedural Terminology (CPT) codes 49505 repair of initial inguinal hernia, age > 5y/o International Classification of Diseases, 9th Revision (ICD-9) codes 550 Inguinal hernia All analysis was performed using SPSS Chi square tests www.hcup-us.ahrq.gov/tools_software.jsp

  22. CCS code assignment for general surgical procedures *CCS codes do not identify liver and pancreas by individual codes. They were reclassified as: Liver = CCS 245: CPT 47000-47130; 47300-47399 Pancreas = CCS 246: CPT 48000-48548; 48999

  23. CCS Code Assignment for Surgical Specialty Procedures

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