THE ROLE OF THE PHYSICIAN IN EFFECTING CHANGE IN-HOSPITAL CHARGE FOR RADICAL PROSTATECTOMY

BACKGROUND: Continuing effort is being made to provide the best medica l care in a cost-effective manner, requiring an evaluation of factors that control charges. The number of cases of carcinoma of the prostate gland and the number of radical retropubic prostatectomies performed have increased in recent years, with an estimate of several hundred mi llion dollars being spent annually oh this procedure in the United Sta tes of America. Because physicians are reported to effect the majority of charges for a hospitalization, this study examines the influence o f notification of the physician of hospital charges on the overall hos pital charges for radical retropubic prostatectomy. STUDY DESIGN: Tota l hospital charge and duration per hospitalization were determined for all patients having radical prostatectomies performed at five communi ty hospitals in Richmond, VA, between January 1991 and December 1993. Patients included 625 males diagnosed with carcinoma of the prostate g land undergoing radical prostatectomy by one of 20 urologists from sev eral different private practice groups. Halfway into the time period s tudied, physicians were notified of data collection and of factors tha t seemed to have a role in hospital charges, Total hospital charges be fore and after physician notification were measured to determine wheth er or not physicians could effect hospital charges. RESULTS: Overall, hospital charges decreased significantly after notification of physici ans in the study. The decline in total charges continued throughout th e follow-up period, Duration of hospitalization decreased throughout t he entire study period, while total charge per hospital day increased. CONCLUSIONS: Physician awareness of hospital charges for operative pr ocedures and accompanying hospitalizations may influence the overall d ecrease in charges.