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Annals of Surgery:
doi: 10.1097/SLA.0000000000000656
Original Articles

Increasing Access to Specialty Surgical Care: Application of a New Resource Allocation Model to Bariatric Surgery

Leroux, Eric J. MD, MBA*,†; Morton, John M. MD, MPH, MHA; Rivas, Homero MD, MBA

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Abstract

Objectives: To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care.

Background: The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost.

Methods: Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated.

Results: In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension.

Conclusions: Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.

© 2014 by Lippincott Williams & Wilkins.

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