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Hospital quality and the cost of inpatient surgery in the United States.
- Source :
-
Annals of surgery [Ann Surg] 2012 Jan; Vol. 255 (1), pp. 1-5. - Publication Year :
- 2012
-
Abstract
- Context: Payers, policy makers, and professional organizations have launched a variety of initiatives aimed at improving hospital quality with inpatient surgery. Despite their obvious benefits for patients, the likely impact of these efforts on health care costs is uncertain. In this context, we examined relationships between hospital outcomes and expenditures in the US Medicare population.<br />Methods: Using the 100% national claims files, we identified all US hospitals performing coronary artery bypass graft, total hip replacement, abdominal aortic aneurysm repair, or colectomy procedures between 2005 and 2007. For each procedure, we ranked hospitals by their risk- and reliability-adjusted outcomes (complication and mortality rates, respectively) and sorted them into quintiles. We then examined relationships between hospital outcomes and risk-adjusted, 30-day episode payments.<br />Results: There was a strong, positive correlation between hospital complication rates and episode payments for all procedures. With coronary artery bypass graft, for example, hospitals in the highest complication quintile had average payments that were $5353 per patient higher than at hospitals in the lowest quintile ($46,024 vs $40,671, P < 0.001). Payments to hospitals with high complication rates were also higher for colectomy ($2719 per patient), abdominal aortic aneurysm repair ($5279), and hip replacement ($2436). Higher episode payments at lower-quality hospitals were attributable in large part to higher payments for the index hospitalization, although 30-day readmissions, physician services, and postdischarge ancillary care also contributed. Despite the strong association between hospital complication rates and payments, hospital mortality was not associated with expenditures.<br />Conclusions: Medicare payments around episodes of inpatient surgery are substantially higher at hospitals with high complications. These findings suggest that local, regional, and national efforts aimed at improving surgical quality may ultimately reduce costs and improve outcomes.
- Subjects :
- Aftercare economics
Aged
Aged, 80 and over
Ancillary Services, Hospital economics
Aortic Aneurysm, Abdominal economics
Aortic Aneurysm, Abdominal surgery
Arthroplasty, Replacement, Hip economics
Arthroplasty, Replacement, Hip mortality
Cohort Studies
Colectomy economics
Coronary Artery Bypass economics
Coronary Artery Bypass mortality
Cost-Benefit Analysis statistics & numerical data
Episode of Care
Female
Hospital Mortality
Humans
Insurance, Physician Services economics
Male
Patient Readmission economics
Postoperative Complications economics
Postoperative Complications mortality
Surgical Procedures, Operative mortality
United States
Health Care Costs statistics & numerical data
Health Expenditures statistics & numerical data
Hospitalization economics
Medicare economics
Quality of Health Care economics
Surgical Procedures, Operative economics
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1140
- Volume :
- 255
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 22156928
- Full Text :
- https://doi.org/10.1097/SLA.0b013e3182402c17