Surgical markup in lung cancer resection, 2015-2020Central MessagePerspective
Eric Robinson, MD, MSc,
Parth Trivedi, MD, MSc,
Sean Neifert, MD,
Omeko Eromosele, BA,
Benjamin Y. Liu, MD,
Brian Housman, MD,
Ilkka Ilonen, MD, PhD,
Emanuela Taioli, MD, PhD,
Raja Flores, MD
Affiliations
Eric Robinson, MD, MSc
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
Parth Trivedi, MD, MSc
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
Sean Neifert, MD
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
Omeko Eromosele, BA
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
Benjamin Y. Liu, MD
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
Brian Housman, MD
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
Ilkka Ilonen, MD, PhD
Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
Emanuela Taioli, MD, PhD
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Health System, New York, NY
Raja Flores, MD
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY; Address for reprints: Raja Flores, MD, Ames Professor of Cardiothoracic Surgery Chairman, Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1023, New York, NY 10029.
Objective: The objective of this study was to assess procedure markup (charge-to-cost ratio) across lung resection procedures and examine variability by geographic region. Methods: Provider-level data for common lung resection operations was obtained from the 2015 to 2020 Medicare Provider Utilization and Payment Data datasets using Healthcare Common Procedure Coding System codes. Procedures studied included wedge resection; video-assisted thoracoscopic surgery; and open lobectomy, segmentectomy, and mediastinal and regional lymphadenectomy. Procedure markup ratio and coefficient of variation (CoV) was assessed and compared across procedure, region, and provider. The CoV, a measure of dispersion defined as the ratio of the SD to the mean, was likewise compared across procedure and region. Results: Median markup ratio across all procedures was 3.56 (interquartile range, 2.87-4.59) with right skew (mean, 4.13). Median markup ratio was 3.59 for lymphadenectomy (CoV, 0.51), 3.13 for open lobectomy (CoV, 0.45), 3.55 for video-assisted thoracoscopic surgery lobectomy (CoV, 0.59), 3.77 for segmentectomy (CoV, 0.74), and 3.80 for wedge resection (CoV, 0.67). Increased beneficiaries, services, and Healthcare Common Procedure Coding System score (total) were associated with a decreased markup ratio (P < .0001). Markup ratio was highest in the Northeast at 4.14 (interquartile range, 3.09-5.56) and lowest in the South (Markup ratio 3.26; interquartile range, 2.68-4.02). Conclusions: We observe geographic variation in surgical billing for thoracic surgery.
