Economic aspects of lung volume reduction surgery

Objective: To investigate the economics of lung volume reduction surgery. Design: Medical center and physician charges obtained from billing records. Setting: Academic health center. Patients: Twenty-three consecutive patients undergoing lung volume reduction surgery at a single institution who were discharged from the hospital prior to November 1, 1995. Outcome measures: Length of hospital stay, mortality, medical center charges and professional fees, and sponsor reimbursement. Results: Median hospital stay was 8.0 days and there were no deaths. The median charge was $26,669 (range, $20,032 to $75,561) of which 73% was for medical center services and 27% was for physician services. Fees for medical center rooms and operating suite time accounted for 71% of medicals. Total charges were directly related to length of stay (r(2) = 0.95). Median reimbursement for medical center services was $22,264 (114%; range, $13,333 to $123,362) and for physician services was $2,783 (34%; range, $2,597 to $11,265), resulting in a median total reimbursement that represented 94% of total charges. The median reimbursement-to-cost ratio was 1.22, compared with 1.05 for all medical services in fiscal year 1995. Conclusions: These data must now be assessed relative to outcomes such as quality of life, patient function, and long-term survival to determine cost-effectiveness of lung volume reduction surgery.