To improve patient outcomes and increase transparency, Urology and Orthopaedic specialists now have the latest data showing the differences in surgical practice for seven different procedures.
Variations in cost, out-of-pockets and rates of readmission are revealed in the latest data released by Medibank and the Royal Australasian College of Surgeons (RACS) to prompt discussion on how to achieve better outcomes for patients and highlight potentially unwarranted variation.
Medibank Chief Medical Officer Dr Linda Swan said Medibank is committed to improving transparency as a way to improve healthcare outcomes, affordability and experience, and the partnership with RACS is vital to interpreting Medibank’s data.
“The latest Surgical Variance Reports for Urology and Orthopaedic procedures give surgeons and other health stakeholders access to important information on key indicators such as the length of patient stay, rates of readmission and prices charged for services. This information hasn’t traditionally been available,” Dr Swan said.
“From this latest data, we can see there’s a lot of variability in out-of-pocket costs charged by surgeons depending on where you live, which may be the result of factors beyond just the complexity of the surgery or patient. It’s important that patients know to ask their specialist about out-of-pocket costs if they have concerns,” Dr Swan said.
Royal Australasian College of Surgeons President John Batten said RACS is committed to ensuring surgeons have the information they need to understand clinical variance across their specialty.
“This is about looking at the quality of care in the system and how we can use these reports as an educative process: where there are surgeons that are outliers, how can they improve their practice in line with their peers? We are committed to continuous improvement in clinical practice in Australia,” Mr Batten said.
The Surgical Variance Report – Urology revealed that in 2014-15 and 2015-16:
- 7,167 cystoscopy with resection procedures were funded by Medibank in private hospitals (usually to treat bladder cancer). In 27 per cent of cases, patients were reoperated on within six months of discharge from hospital. The report asks surgeons to consider if this is the expected rate for re-operating. The average separation cost (the total cost of the surgery and hospital stay) varied between $1,879 and $8,716 depending on the surgeon. 91 per cent of patients in the ACT and 34 per cent of patients in NSW were charged an out-of-pocket by their surgeon, compared to only 13 per cent of patients in Victoria and 12 per cent in South Australia.
- 22,448 cystoscopy without resection procedures were funded by Medibank in private hospitals (to examine the inside of the bladder). The average separation cost (the total cost of the surgery and hospital stay) varied between $783 and $4,669 depending on the surgeon. 87 per cent of patients in the ACT and 43 per cent of patients in NSW were charged an out-of-pocket by their surgeon, compared to only 16 per cent of patients in Victoria and 37 per cent in Queensland.
- 2,727 radical prostatectomy procedures were funded by Medibank in private hospitals (usually to treat prostate cancer). This procedure often includes the use of robotics, which can substantially increase the cost, but a recent scientific study comparing robotic and traditional prostate surgery showed that patients had similar results at 12 weeks after surgery[1]. The average separation cost (the total cost of the surgery and hospital stay) varied between $14,553 and $55,928 depending on the surgeon. All patients in the ACT and 88 per cent of patients in NSW were charged an out-of-pocket by their surgeon, compared to only 35 per cent of patients in Victoria and 73 per cent of patients in Western Australia and South Australia.
The Surgical Variance Report – Orthopaedic revealed that in 2014-15 and 2015-16:
- 9,947 hip replacements were funded by Medibank in private hospitals. The average separation cost (the total cost of the surgery and hospital stay) varied between $19,439 and $42,007 depending on the surgeon. The average out-of-pocket charged by a surgeon varied between $0 and $5,567, with the average out-of-pocket charged by a surgeon in NSW at $2,673 and the average out-of-pocket charged by a surgeon in Victoria at $1,997. The lowest average out-of-pocket charge from a surgeon by state is in South Australia ($556).
- 13,807 knee replacements were funded by Medibank in private hospitals. The average separation cost (the total cost of the surgery and hospital stay) varied between $17,797 and $30,285 depending on the surgeon. The average out-of-pocket charged by a surgeon varied between $0 and $5,137, with the average out-of-pocket charged by a surgeon in NSW at $2,499 and the average out-of-pocket charged by a surgeon in Victoria at $1,609. The lowest average out-of-pocket charge from a surgeon by state is in South Australia ($397).
- For both hip and knee replacements, the data shows that some surgeons didn’t send any patients to rehabilitation, while others sent every patient to rehab, highlighting the wide variation in the practice and the need for careful consideration as to whether patients are being appropriately referred to private rehabilitation. Medibank and RACS are working together on further research into post-joint replacement rehabilitation.
- 4,214 knee cruciate ligament (ACL) repair procedures were funded by Medibank in private hospitals. The average separation cost (the total cost of the surgery and hospital stay) varied between $5,076 and $13,950 depending on the surgeon. The average out-of-pocket charged by a surgeon varied between $0 and $2,907, with the average surgeon out-of-pocket in NSW at $2,248 and the average surgeon out-of-pocket in Victoria at $1,671. The lowest average out-of-pocket charge from a surgeon by state is in South Australia ($415).
The first round of Medibank-RACS Surgical Variance Reports was released in 2016, based on 2014 data. This second series of reports provides data for the financial years 2015 and 2016. The data contained in these reports is taken from de-identified Medibank claims data that RACS has considered and interpreted. No individual surgeon or patient can be identified.
The full reports are available under ‘2017’ at https://www.surgeons.org/policies-publications/publications/surgical-variance-reports/
Media enquiries: Bronwyn Perry - 0438 545 090 / bronwyn.perry@medibank.com.au
[1] Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016; 388: 1057-1066.