The main purpose of this report is to help patients compare Utah health care facilities in gallbladder removal based on utilization and charges. If you or someone you know has gallbladder problems, you may find this report helpful when considering where to receive treatment.
To learn important information about gallbladder removal, click on “Gallbladder Resources” to the right in this report and visit the American College of Surgeons web site.
Did you know?
- Most people with gallstones do not have symptoms
- The gallbladder is a pear-shaped organ near your liver
- About 150 Utahns have their gallbladder removed every week
How did Utah’s rate of laparoscopic gallbladder removal compare with the nation?
In general, laparoscopic gallbladder removal requires smaller incisions and results in quicker recovery for patients than open gallbladder removal. However, the doctor may start a laparoscopic surgery, find unanticipated problems and need to change to an open surgery. Other patients with known complex medical problems or history may require planned open surgery. In these cases, open surgery is not necessarily an indication of lower quality of care.
For laparoscopic gallbladder removal in 2006, Utah overall had a higher rate (83.5%) than similar adult inpatients nationwide (75.9%). Utah overall means all Utah health care facilities combined. Facilities include hospitals that treat inpatients and hospitals and ambulatory surgery centers that treat outpatients. Measures used are in square brackets. For more details, see the Technical Document.
- Among the 22 Utah facilities that treated 30 or more adult gallbladder removal inpatients in 2006:
- 1,808 (83.5%) of 2,164 inpatient gallbladder removals were laparoscopic [AHRQ IQI 23].
- 5,923 additional outpatient laparoscopic gallbladder removals were performed [ICD-9-CM procedure code 51.23].
- 95.6% (7,731 out of 8,087) of gallbladder removals among inpatients plus outpatients were laparoscopic.
When each Utah facility that performed at least 30 gallbladder removals is compared to similar inpatients nationwide in 2006:
- 17 facilities had a higher percentage of inpatient laparoscopic gallbladder removals.
- 5 additional facilities had a lower percentage. These facilities tend to treat inpatients with more complex gallbladder problems and medical history.
Note: that many factors can affect treatment for gallbladder problems at a particular facility. Read more in About the Data.
How did facility charges differ among Utah facilities?
Average facility charges among adults for the gallbladder removal procedures in this report differed widely in 2005 for inpatients and outpatients. Measures used are in parentheses. For more details, see the Technical Document.
$2,841 to $11,976 among 36 Utah facilities that reported charge for laparoscopic outpatients [ICD-9-CM procedure code 51.23].
$7,017 to $19,090 among 33 Utah facilities that reported charge for laparoscopic inpatients [APR-DRG 263] at the minor/moderate level of illness.
As expected, average facility charge for inpatients treated at the major/extreme level of illness was higher. In this report, outpatients are not grouped into two levels of illness.
Note: usually inpatients spend at least 24 hours in the facility. Outpatients usually spend less than 24 hours in the facility.
Many factors will affect facility charges. Read more in About the Data.
This measure is not intended to be an indicator of quality of care. Whether a facility performs a lower percentage of gallbladder removal by laparoscopic surgery often depends on its patients’ medical history and how ill they are. You should consult your health care professional for help in understanding the best treatment options for you. Read more in About the Data.
Many factors will affect the cost of your hospital stay. Read more in About the Data.Methods and Measures Used for the Utilization Section of this Report
Why use these indicators/measures?
AHRQ Inpatient Quality Indicators
The Agency for Healthcare Research and Quality (AHRQ), a federal agency charged with overseeing quality of care, developed the Inpatient Quality Indicators (IQIs). The IQIs allow comparison among Utah inpatients and similar inpatients nationwide based on the State Inpatient Databases 2005, the most recently available database, through the expected rate. These databases represent about 90% of all inpatients in the U.S. from participating states in 2005. The Healthcare Cost and Utilization Project (HCUP) collects these data every year.
The AHRQ IQIs are nationally recognized indicators and are used in this report in compliance with the mandates of Senate Bill 132, the Health Care Consumer’s Report Bill, which was passed in 2005.
Measures for average facility charge are All Patient Refined Diagnosis Related Groups (APR-DRGs) for similar, though not identical, kinds of gallbladder procedures in this report’s quality of care section. APR-DRG software, widely used in health care research, organizes about 20,000 clinical diagnoses and procedures into about 300 groups. Read this report’s Technical Document to learn more.
Each APR-DRG has four levels for severity of illness. This report shows average facility charge for minor and moderate severity of illness levels combined and average facility charge for major and extreme severity of illness levels combined. APR-DRGs and severity of illness levels apply to inpatients but not to outpatients. This report uses APR-DRG version 20.0, because the Agency for Healthcare Research and Quality (AHRQ) uses it for expected rate in the Inpatient Quality Indicators (IQIs).
Please note that other Utah Department of Health reports that include average charge information use APR-DRG Version 15.0 for data from 2004 and earlier.
Also be aware that the number of patients in the IQI may not be the same as the number of patients for similar APR-DRGs. First, the APR-DRGs are hierarchical, mutually exclusive groups of conditions and procedures. A patient’s APR-DRG reflects that patient’s most resource-intensive condition and/or procedure. Second, each IQI has patient exclusion and inclusion criteria that may not be the same as those for a similar APR-DRG. For more information, see this report’s Technical Document.
About the Data
Where do the data come from?
Most of the data in this report come from health care facility claim records. Health care facilities (facilities for short) in this report include Utah hospital and freestanding ambulatory surgery centers. Utah facilities are required by law to submit a standard set of information about each inpatient who spends at least 24 hours in the facility and about each outpatient who spends up to 24 hours in the facility to the Office of Health Care Statistics, Utah Department of Health, for the Utah Hospital Discharge Database. The Agency for Healthcare Research and Quality (AHRQ), a federal agency in charge of quality of care, provided national information. For further information visit the AHRQ Web site….
Have the data been verified by others?
Yes. Utah facilities review the data for accuracy during a review period of at least 30 days while the report is being developed. They also review the completed report before it is released. Facilities may submit comments to be posted online as part of the report.
Why use these indicators/measures?
SB 132 mandates that the comparison reports use nationally recognized quality standards. A federal agency charged with overseeing health care quality, the Agency for Healthcare Research and Quality (AHRQ), developed the Inpatient Quality Indicators (IQIs). The IQIs allow comparison among Utah facilities with similar patients nationwide. This report shows one IQI for inpatient laparoscopic gallbladder removal. Read more information on the AHRQ IQIs.
The IQIs are designed to be used for inpatients, so outpatients are not included in the report’s IQI table. Based on research in the 1990s, AHRQ includes rate of laparoscopic gallbladder removal among its quality indicators, as higher rates indicate adoption of a new procedure that is usually less expensive and less traumatic to patients than open gallbladder removal. However, many experts now suggest that 100% laparoscopic gallbladder removal should not be a goal for optimal health care. For some patients, laparoscopic gallbladder removal is not possible or is too risky. Such patients require more extensive procedures, such as open gallbladder removal. This report includes the IQI for laparoscopic gallbladder removal as a utilization measure.
The measure for average charge is an All Patient Refined Diagnosis Related Group (APR-DRG) for similar, though not identical, conditions and procedures among inpatients. For outpatients, the measure is the ICD-9-CM procedure code 51.23, as outpatients do not have APR-DRGs.
What are the limitations of utilization comparisons in the report?
Many factors affect a facility’s performance on utilization measures. Such factors include the facility’s size, the number of gallbladder patients treated, available specialists, teaching status and especially the medical history of the facility’s patients and how ill those patients are. Facilities that treat high-risk (very ill) patients may have higher percentages of open surgeries than facilities that transfer these patients. Facilities also may report patient diagnosis codes differently, which could impact the comparison of utilization measurement among facilities. Utilization indicators adjust for how ill each facility’s patients are, but the adjustment may not capture the full complexity of the patient’s condition. The Utah Hospital Discharge Database includes up to nine diagnoses and up to six procedures for each patient. Some patients have additional diagnoses and procedures that are not included in this database. As a result, the measures of inpatient illness may not be complete.
Higher-risk gallbladder removal patients are usually inpatients. Lower-risk gallbladder removal patients are often outpatients. See Glossary and Technical Document.
What are the limitations of the charge comparisons in the report?
The average charge shown in this report differs from “costs,” “reimbursement,” “price” and “payment.” Different payers have different arrangements with each facility for payment. Many factors will affect the cost of your facility stay, including whether you have health insurance, the type of insurance and the billing procedures at the facility. This report excludes outlier (unusually high) charge cases and length of stay cases from the calculation of average charge for inpatients. It does not exclude outlier charge for outpatients (see Glossary). While APR-DRGs do consider levels for each inpatient’s severity of illness, these levels may not completely reflect the complexity of the inpatient’s condition.
Outpatients do not have levels for severity of illness, whereas inpatients do have levels for severity of illness.
Please be aware that information in this report is neither intended nor implied to be a substitute for professional medical advice. Always ask questions and seek the advice of your physician or other qualified health provider prior to starting any new treatment.