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Day Admission Surgery Program in a Prospective Payment System: What Are the Financial Incentives?

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Summary

Day admission surgery (DAS) can reduce hospital costs but may decrease reimbursement under prospective payment systems. Careful patient selection and workflow adjustments are crucial for financial viability in DAS programs.

Keywords:
Day admission surgery (DAS)costsfinancial penaltiesincentivesprospective payment system (PPS)revenue

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Area of Science:

  • Healthcare Economics
  • Surgical Operations Management

Background:

  • Day admission surgery (DAS) aims to improve patient experience and reduce hospital costs by minimizing inpatient stays.
  • Prospective payment systems (PPS) may create financial disincentives for hospitals implementing DAS due to reduced reimbursement.

Purpose of the Study:

  • To analyze the financial impact of DAS on hospital revenue within a Swiss diagnosis-related group (SwissDRG) prospective payment system.
  • To compare revenue generated by DAS with traditional pre-operative admission (No DAS) and estimate cost savings.

Main Methods:

  • A 4-month prospective study (2021) involving patients from various surgical sub-specialties undergoing DAS.
  • Revenue analysis comparing DAS and No DAS scenarios under SwissDRG policy.
  • Micro-costing approach to estimate cost savings from avoiding pre-operative hospitalization.

Main Results:

  • 105 patients underwent DAS, generating CHF 1,209,840 in revenue.
  • 24% of DAS patients were financial outliers, incurring a mean discount of CHF 4192.
  • DAS yielded a mean revenue of CHF 7320, significantly lower than CHF 11,510 for No DAS (P=.007).

Conclusions:

  • Implementing DAS in a PPS requires anticipating financial penalties, especially without strict patient selection criteria, to maintain financial balance.
  • Hospitals should revise workflows to manage fixed costs effectively for a larger patient volume under DAS to mitigate financial risks.