Surgical complications: Improved quality will lead to financial gain for hospitals, payers

Efforts to improve surgical quality will also lead to greater financial rewards for both hospitals and third-party health payers, according to research published in JAMA Surgery.

Researchers set out to evaluate costs associated with surgical quality and the relative financial burden on hospitals and payers. The study looked at seven years of internal cost accounting data from the University of Michigan Health System and complication data from the Michigan Surgical Quality Collaborative. Between the two data sets, the analysis encompassed 5,120 surgical care episodes across 24 procedure groups.

The research team then compared reimbursement costs, hospital costs and hospital profit margins for patients with and without complications. They found adjusted mean hospital costs were $19,626 higher for patients with complications, whereas they cost payers an adjusted $18,497 more in reimbursements. Hospital profit margins, meanwhile, fell from 5.8 percent for patients without complications to 0.1 percent for patients without complications. Their results, they note, contradict a 2013 study published in JAMA, which found post-surgical complications strengthen hospital profits.

The findings, the researchers write, highlight the financial benefits for both payers and hospitals to avoid surgical complications. However, researchers warn that healthcare leaders must not take advantage of the correlation by "cherry picking" the healthiest patients rather than focusing their efforts to improve quality..

To learn more:
- here's the study

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