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November 2016

Strategies for Improving Surgical Care: When Is Regionalization the Right Choice?

Author Affiliations
  • 1Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
  • 3Department of Surgery, University of Michigan, Ann Arbor
JAMA Surg. 2016;151(11):1001-1002. doi:10.1001/jamasurg.2016.1059

Regionalizing high-risk surgery by restricting care to high-volume centers of excellence is a quality-improvement strategy with intuitive appeal. Decades of research have shown that the highest-volume hospitals have better outcomes for major surgery.1 Accordingly, 3 prominent medical centers—Dartmouth-Hitchcock Medical Center, Johns Hopkins Medicine, and the University of Michigan—recently announced a “volume pledge” to restrict their own facilities and surgeons from performing any of 10 selected procedures unless they meet volume criteria.2,3 Apart from a voluntary pledge, other policy approaches to regionalization have included the refusal to reimburse low-volume facilities (as Medicare currently does for solid-organ transplants) and tiered insurance benefits (ie, reducing out-of-pocket payments at high-volume hospitals).