Biliary Obstruction Clinical Trial
Official title:
The Impact of Cost Itemization on Resource Utilization With ERCP
The purpose of the study is to determine if endoscopist notification of accessory cost
results in altered resource utilization related to the total cost and number of accessories
used in ERCP.
This study will be a prospective cost--analysis study. Only chart review of PHI removed
records will be used. The only intervention used is that endoscopists will be made aware of
the cost of accessories used in the second phase of the study following each ERCP.
The investigators are in an era of increased medical cost consciousness. Medical education
and post--graduate education incorporates cost savings and appropriate diagnostic test
selection based on expense as one aspects of the decision process. This era now focuses on
what is best for the patient with the understanding that the cost to the patient and cost to
the overall health care system matters. Not only is this apart of postgraduate training but
now being implemented as part of Medicare reimbursement to provide low cost and high quality
care. Incidence of pancreatic and biliary disease is increasing. ERCP is a vital tool for
therapeutic intervention. The costs of these procedures, to both patients and hospitals, have
caused some to question the amount of accessories used as well as the poor reimbursement
provided by Medicare and insurers. Studies have indicated that hospitals actually lose money
with each ERCP used and their use is being limited many times to tertiary care centers.
This study is a prospective cost-identification analysis of accessories used during the ERCP.
The study will be conducted in two phases. Each phase will include at least 71 ERCP
procedures. All consecutive patients undergoing ERCP will be included. For the first phase of
the study the physicians performing the procedure will not be made aware of the study and
also will not be briefed at the end of the procedure with the number of accessories used
during the procedure and the dollar value of the accessories. For the second phase of the
study, endoscopist will be briefed by the endoscopy manager after completion of each
procedure about the total number of accessories used and the dollar value of the accessories
used during the procedure.
During the study period, all gathered information will be deidentified but the procedure
indication and whether it was successful or not will be collected. Only deidentified
information will be collected. Endoscopists will not be aware of the study to avoid a
Hawthorne effect. The endoscopists resource utilization is what is being studied. They will
be debriefed at completion of protocol.
ERCP's requiring cholangioscopy (spyglass), stent removal alone, or just stent exchange will
be excluded from the cost analysis, because of the atypical nature of the procedures and the
number of accessories used during these procedures may not reflect the number of accessories
used during a typical procedure. For both groups, if an endoscopic ultrasound is used for
gaining biliary access it will be included in the cost analysis of this study. Both
outpatient and inpatients will be included for both groups. All investigator patients will be
excluded from the analysis.
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