February 14, 2019

Use of ‘hot spotting’ to identify high-cost surgery patients

By: Judy Mathias

Editor’s Note

Because a subset of patients are responsible for a disproportionate share of Medicare spending, targeting high-cost patients (ie, “hot spotting”) for cost containment efforts would be an effective strategy to reduce costs in surgical patients, this study finds.

Using Medicare claims data from 2010 to 2013, University of Michigan, Ann Arbor, researchers found that patients in the highest decile of spending accounted for a disproportionate share of costs:

  • 30% in colectomy
  • 22% in coronary artery bypass grafting (CABG)
  • 19% in total hip arthroplasty
  • 18% in total knee arthroplasty.

Multivariate analysis found that patients with three or more comorbidities had significantly higher costs than healthier patients.

“Hot spotting” is well developed in medical patients, but has not been performed in surgical patients, the researchers say. Population-based management of surgical expenditures requires identification of these high-cost patients.


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