Editor’s note: Due to the COVID-19 pandemic, the 2021 Triological Society Combined Sections Meeting was held virtually on Jan. 29-30. The physical distance didn’t stop otolaryngologists in every specialty area from discussing the latest treatments, techniques, and issues in otolaryngology research and clinical practice.
Explore This IssueMarch 2021
It has been increasingly recognized that hospitals performing a high volume of procedures tend to have better outcomes in those procedures, and now the role of market concentration is coming into better focus.
Christine Gourin, MD, MPH, a professor of otolaryngology–head and neck cancer at Johns Hopkins School of Medicine in Baltimore, has led research using national healthcare data to see how hospitals in highly concentrated markets with low competition compare on laryngectomy care with hospitals in unconcentrated markets with high competition. The research is part of Johns Hopkins’ participation in the “volume pledge,” in which Hopkins, Dartmouth College, and the University of Michigan have pledged to limit certain types of procedures at low-volume centers.
Examining laryngectomy procedures performed across the country from 2003 to 2011, researchers found that 69.2% were performed at hospitals in highly concentrated markets that are noncompetitive, while 26.2% were performed in unconcentrated, competitive markets. Most high-volume hospitals (68.0%) were located within highly concentrated markets. Researchers found that unconcentrated, less-competitive markets were associated with 28% higher costs, relative to markets with moderate and high concentration (JAMA Otolaryngol Head Neck Surg. 2019;145:939-947).
Other work by Dr. Gourin and her colleagues has found that the majority of extreme mark-up hospitals—those that charge the most compared to what it actually costs to provide the care—are not high-volume hospitals. “The more concentrated the market—in other words, the less competitive it is—the less likely it is to be a high-markup hospital,” she said. “And the less likely it is to have a for-profit hospital status.”
Within a large healthcare market, consolidation of larynx cancer care has favorable financial implications, and within these large markets, there’s a greater cost savings when the care within a particular hospital or healthcare system is provided at the high-volume hospital. —Christine Gourin, MD, MPH
For laryngectomy, then, consolidating the volume of surgeries into markets that are less competitive could be a way to improve quality and value, she suggested. “Within a large healthcare market, consolidation of larynx cancer care has favorable financial implications, and within these large markets, there’s a greater cost savings when the care within a particular hospital or healthcare system is provided at the high-volume hospital,” Dr. Gourin said.
There are potential hurdles to this strategy, she acknowledged, such as whether high-volume hospitals can increase their surgical load, especially with a backlog of cases due to COVID-19. Another challenge is that some patients, including many who live in the northeast part of the U.S., don’t want to travel very far for their care.
Robert Ferris, MD, PhD, director of the University of Pittsburgh Hillman Cancer Center, discussed the ways that surgeons were credentialed in the ECOG-ACRIN 3311 Trial that examined radiation dosing after surgical resection. For the trial, the “up-front-surgery had to be standardized into high quality, or else you couldn’t ask a question about adjuvant therapy,” Dr. Ferris said.