[Congressional Record Volume 144, Number 118 (Wednesday, September 9, 1998)]
[Extensions of Remarks]
[Pages E1664-E1665]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


         CENTERS OF EXCELLENCE: A WAY TO SAVE LIVES AND DOLLARS

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, September 9, 1998

  Mr. STARK. Mr. Speaker, Congress should enact legislation to allow 
Medicare to concentrate certain difficult surgical procedures in 
hospitals of special excellence in those procedures. If we did this, we 
would certainly save lives because the data is overwhelming that some 
hospitals do difficult procedures better than other hospitals. Better 
patient outcomes also means savings to Medicare by the avoidance of 
complications and repeat surgery. It also offers the chance for 
Medicare to negotiate a bundled, lower payment: Medicare will guarantee 
a higher volume of patients in exchange for volume price discounts.
  I've introduced legislation to establish a Centers of Excellence 
program, HR 2726, which I hope can be enacted in the next Congress.
  The Annals of Surgery's July 1998 issue contains an article which 
proves, once-again, what a life-saver this type of program can be. 
Following is the abstract of the article, describing using centers of 
excellence for pancreaticoduodenectomy--a ``complex, high-risk general 
surgical procedure usually performed for malignancies of the pancreas'' 
and duodenum area:

Statewide Regionalization of Pancreaticoduodenectomy and its Effect on 
                         In-Hospital Mortality


                               Objective

       This study examined a statewide trend in Maryland toward 
     regionalization of pancreaticoduodenectomy over a 12-year 
     period and its effect on statewide in-hospital mortality 
     rates for this procedure.

[[Page E1665]]

                        Summary Background Data

       Previous studies have demonstrated that the best outcomes 
     are achieved in centers performing large numbers of 
     pancreaticoduodenectomies, which suggests that 
     regionalization could lower the overall in-hospital mortality 
     rate for this procedure.


                                Methods

       Maryland state hospital discharge data were used to select 
     records of patients undergoing a pancreaticoduodenectomy 
     between 1984 and 1995. Hospital is were classified into high-
     volume and low-volume provider groups. Trends in surgical 
     volume and mortality rates were examined by provider groups 
     and for the entire state. Regression analyses were used to 
     examine whether hospital share of pancreaticoduodenectomies 
     was a significant predictor of the in-hospital mortality 
     rate, adjusting for study year and patient characteristics. 
     The portion of the decline in the statewide in-hospital 
     mortality rate for this procedure attributable to the high-
     volume provider's increasing share was determined.


                                 Results

       A total of 795 pancreaticoduodenectomies were performed in 
     Maryland at 43 hospitals from 1984 to 1995 (Maryland 
     residents only). During this period, one institution 
     increased its yearly share of pancreaticoduodenectomies from 
     20.7% to 58.5%, and the statewide in-hospital mortality rate 
     for the procedure decreased from 17.2% to 4.9%. After 
     adjustment for patient characteristics and study year, 
     hospital share remained a significant predictor of mortality. 
     An estimated 61% of the decline in the statewide in-hospital 
     mortality rate for the procedure was attributable to the 
     increase in share of discharges at the high-volume provider.


                              Conclusions

       A trend toward regionalization of pancreaticoduodenectomy 
     over a 12-year period in Maryland was associated with 
     significant decrease in the statewide in-hospital mortality 
     rate for this procedure, demonstrating the effectiveness of 
     regionalization for high-risk surgery.

     

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