Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA.
Ann Surg. 2012 Jan;255(1):1-5. doi: 10.1097/SLA.0b013e3182402c17.
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.
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.
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.
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.
支付方、政策制定者和专业组织已经启动了各种旨在提高住院手术医院质量的举措。尽管这些举措对患者有明显的好处，但它们对医疗保健成本的可能影响尚不确定。在这种情况下，我们研究了美国医疗保险人群中医院结果与支出之间的关系。
我们使用全国 100%的索赔文件，确定了在 2005 年至 2007 年间进行冠状动脉旁路移植术、全髋关节置换术、腹主动脉瘤修复术或结肠切除术的所有美国医院。对于每种手术，我们根据其风险和可靠性调整后的结果（分别为并发症和死亡率）对医院进行排名，并将其分为五分位数。然后，我们研究了医院结果与风险调整后 30 天发病支付之间的关系。
所有手术的医院并发症发生率与发病支付之间存在很强的正相关关系。例如，在冠状动脉旁路移植术中，并发症发生率最高的医院的平均支付比并发症发生率最低的医院高出 5353 美元/患者（46024 美元比 40671 美元，P<0.001）。结直肠切除术（每例患者 2719 美元）、腹主动脉瘤修复术（5279 美元）和髋关节置换术（2436 美元）的并发症发生率较高的医院支付也较高。低质量医院较高的发病支付主要归因于指数住院治疗的较高支付，尽管 30 天再入院、医生服务和出院后辅助护理也有贡献。尽管医院并发症发生率与支付之间存在很强的关联，但医院死亡率与支出无关。
并发症发生率较高的医院在住院手术的发病支付方面要高得多。这些发现表明，旨在提高手术质量的地方、区域和国家努力最终可能会降低成本并改善结果。
