Postoperative Complications and Hospital Payment: Implications for Achieving Value.

Area of Science:

• Health Economics
• Surgical Quality Improvement
• Value-Based Healthcare

Background:

• Healthcare systems are shifting towards value-based purchasing, necessitating a clear understanding of costs associated with postoperative complications.
• Accurate cost assessment is vital for stakeholders to evaluate the sustainability of quality in surgical care.

Purpose of the Study:

• To assess hospital reimbursements for postoperative complications across common surgical procedures.
• To provide insights into the financial impact of complications on healthcare providers and payers.

Main Methods:

• Utilized merged data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and Medicare claims (2009-2012).
• Estimated payments for 7 postoperative complications in elective colectomy, total knee arthroplasty, and carotid endarterectomy using multivariable regression models.
• Calculated the impact on hospital marginal costs by incorporating complication incidence rates.

Main Results:

• Uncomplicated procedures had mean payments of ~$13,500 (colectomy), ~$12,300 (TKA), and ~$7,300 (CEA).
• Payments increased per complication by ~$10,996 (colectomy), ~$13,732 (TKA), and ~$8,435 (CEA).
• Prolonged ventilation was the most costly complication, adding ~$14,100 (colectomy) and ~$6,700 (CEA) to mean payments. Marginal costs ranged from 0.82% to 9.2%.

Conclusions:

• Postoperative complications represent a significant marginal cost to Medicare payments and contribute substantially to hospital revenue.
• High-quality clinical registry data are essential for accurately estimating the cost of complications in surgical populations.
• Aligning financial incentives for payers and providers is necessary to enhance the delivery of high-quality surgical care.