Hospital and Payer Costs Associated With Surgical Complications
Hospital and Payer Costs Associated With Surgical Complications
复制标题
DOI：
10.1001/jamasurg.2016.0773
复制
发表时间：
2016-09-01
期刊：
影响因子：
16.9
通讯作者：
Dimick, Justin B.
中科院分区：
文献类型：
--
作者：
Healy, Mark A.;Mullard, Andrew J.;Dimick, Justin B.
重要性 手术并发症的费用增加主要由第三方付款人承担。然而，旨在激励高质量护理的众多政策变化将这一负担更多地转移给了医院。这些政策对医院和付款人的潜在影响知之甚少。目的评估与手术质量相关的成本以及医院和付款人的相对财务负担。设计、设置和参与者我们进行了一项观察性研究，合并了密歇根手术质量协作的并发症数据和密歇根大学卫生系统的内部成本核算数据，从2008年1月2日到2015年4月16日；这些数据的合并文件是在 2015 年 6 月 5 日至 2015 年 7 月 22 日之间创建的。共检查了 24 个外科手术组（17 个普通外科组、6 个血管组和 1 个妇科组）的 5120 次手术护理。我们报告了未经调整和对数转换的风险调整成本。 主要结果和措施 我们比较了有和没有并发症病例的医院成本、第三方报销（即付款人成本）和医院利润率。 结果 5120 名患者的平均 (SD) 年龄为 56.0 (16.4) 岁，其中 2883 名患者 (56.3) 为女性。所有手术的总体并发症发生率为 14.5%（5120 例中的 744 例），普外科为 14.7%（3956 例中的 580 例），血管手术为 15.5%（828 例中的 128 例），妇科手术为 10.7%（336 例中的 36 例）。对于所有研究的手术，与无并发症的患者（16 434 美元）相比，有并发症的患者（36 060 美元）的平均住院费用高出 19 626 美元（119%）。与无并发症患者（17 373 美元）相比，有并发症患者（35 870 美元）的平均第三方报销金额高出 18 497 美元（106%）。因此，通过风险调整，总体利润率从无并发症患者的 5.8% 降至有并发症患者的 0.1%。 结论和相关性 医院和第三方付款人因手术并发症而面临成本增加，而医院的利润率却下降。目前，医院和付款人似乎都有财政激励措施来促进手术质量的提高。
IMPORTANCE Increased costs of surgical complications have been borne mostly by third-party payers. However, numerous policy changes aimed at incentivizing high-quality care shift more of this burden to hospitals. The potential effect of these policies on hospitals and payers is poorly understood.OBJECTIVE To evaluate costs associated with surgical quality and the relative financial burden on hospitals and payers.DESIGN, SETTING, AND PARTICIPANTS We performed an observational study merging complication data from the Michigan Surgical Quality Collaborative and internal cost accounting data from the University of Michigan Health System from January 2, 2008, through April 16, 2015; the merged files from these data were created between June 5, 2015, and July 22, 2015. A total of 5120 episodes of surgical care for 24 surgical procedure groups (17 general surgical, 6 vascular, and 1 gynecologic) were examined. We report unadjusted and log-transformed risk-adjusted costs.MAIN OUTCOMES AND MEASURES We compared hospital costs, third-party reimbursement (ie, payer costs), and hospital profit margin for cases with and without complications.RESULTS The mean (SD) age of the 5120 patients was 56.0 (16.4) years, and 2883 (56.3) were female. The overall complication rate was 14.5% (744 of 5120) for all procedures, 14.7% (580 of 3956) for general surgery, 15.5% (128 of 828) for vascular surgery, and 10.7% (36 of 336) for gynecologic surgery. For all studied procedures, mean hospital costs were $19 626 (119%) higher for patients with complications ($36 060) compared with those without complications ($16 434). Mean third-party reimbursement was $18 497 (106%) higher for patients with complications ($35 870) compared with those without complications ($17 373). Consequently, with risk adjustment, overall profit margin decreased from 5.8% for patients without complications to 0.1% for patients with complications.CONCLUSIONS AND RELEVANCE Hospitals and third-party payers experience increased costs with surgical complications, with hospitals experiencing a reduction in profit margin. Both hospitals and payers appear to currently have financial incentives to promote surgical quality improvement.