American College of Surgeons NSQIP Return on Investment Calculator Prototypes

Hospitals considering participation in quality improvement programs such as ACS NSQIP often lack practical estimates of financial return on investment. We developed 2 calculators to approximate hospital ROI from complication reduction: reduced length of stay (RLOS) and direct cost avoidance (DCA).

Using Healy and colleagues. for complication-associated length of stay and Merkow and colleagues. for complication-attributed direct costs, we constructed RLOS and DCA ROI calculators with risk-adjusted and unadjusted estimates. Relative reductions in postoperative complications associated with NSQIP or similar quality improvement participation were derived from published literature and verified by the authors. ROI was defined as cost savings minus annual program costs, including NSQIP fees, Surgical Clinical Reviewer salary and benefits, and estimated surgeon effort. A base-case hospital was modeled with 2,000 annual inpatient procedures and 4,500 total annual inpatient and outpatient procedures.

All 4 modeled scenarios demonstrated positive ROI. Estimated savings were $1,960,404 (RLOS, risk-adjusted), $1,502,433 (RLOS, unadjusted), $1,636,708 (DCA, risk-adjusted), and $2,306,784 (DCA, unadjusted). After subtracting annual program costs, estimated ROI was $1,710,404, $1,252,433, $1,386,708, and $2,056,784, respectively. In the RLOS model, the greatest modeled savings were associated with pneumonia, urinary tract infection, and organ-space surgical site infection. In the DCA model, the greatest modeled savings were associated wi th deep/organ-space surgical site infection, return to operating room, and ileus.

Both calculators suggested positive financial return associated with sustained, active QI participation. RLOS and DCA offer complementary estimates of value and may function as upper-bound scenario tools for hospitals considering or sustaining NSQIP investment.