Bariatric Study Raises Larger Issues of Healthcare Costs, Quality, and Consumerism

For patients, that expertise translates into shorter hospital stays. Patients having surgery at top-rated hospitals, on average, spent 2.15 days in the hospital. Patients having surgery in low-rated hospitals spent 2.72 days in the hospital. A state-by-state comparison is even more dramatic. Vermont patients, on average, spent 3.26 days in the hospital, while Nevada patients spent 1.56 days in the hospital.

"The really good programs are really good at multiple levels," May says. "They're really dedicated to making a better product. They are looking at the whole spectrum of care. They are looking at proper patient selection. They're looking at educating patients before surgery. They're looking at what are they going to do to optimize the patients medically before they bring them into the hospital. They are standardizing their post-operative care. They are looking at providing good diets. They've been very proactive at addressing everything soup to nuts."

The study analyzed outcomes in 19 states that provide all-payer information for the most common gastric bypass procedures, such as less-invasive laparoscopic procedures, including gastric banding, malabsorbtive procedures, and combined malabsorbtive/restrictive procedures.

May says the disparities in price and outcomes may widen as more insurance companies cover the procedure, more and more increasingly overweight Americans opt for it, and more hospitals, surgeons, and other providers take up the lucrative business line with little if any experience in the field.

"Bariatrics is exploding in terms of how many surgeries are being done because obesity is growing off the charts and that drives a huge expansion in a procedure," May says. "That forces another segment of the provider community to start doing stuff they haven't been doing before. Now you are talking about a huge range of experience between hospitals that have done thousands of these procedures verses hospitals that have done 10, or surgeons that have done hundreds of these procedures versus surgeons who've done five."

If the consumer isn't considering the cost of the procedure, May says maybe the insurance companies should more-aggressively take it upon themselves to find better deals in other hospitals and states. "Frankly, if you are a health insurance company in California, you are better off putting your patients in a first-class seat and flying them to Maryland and having the procedure there and saving a pile of money," he says.