Squires Malcolm H, Staley Christopher A, Knechtle William, Winer Joshua H, Russell Maria C, Perez Sebastian, Sweeney John F, Maithel Shishir K, Staley Charles A
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2015 May;22(5):1739-45. doi: 10.1245/s10434-014-4025-7. Epub 2014 Sep 24.
Despite increasing implementation of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), there are little data on its financial implications. We analyzed hospital cost and reimbursement data within the context of insurance provider type and postoperative complications.
Clinicopathologic variables, hospital costs, and reimbursement for all patients undergoing CRS/HIPEC at a single institution from 2009 to 2013 were analyzed.
A total of 64 patients underwent CRS/HIPEC. Median PCI score was 19, and average operative time was 550 min. Tumor histology included appendiceal (n = 40; 62 %), colorectal (n = 16; 25 %), goblet cell (n = 5; 8 %), and mesothelioma (n = 3; 5 %). Median length-of-stay was 13 days. Complications occurred in 42 patients (66 %), including 13 (20 %) with major (Clavien grade III-IV) complications. Payer mix included 42 private insurance and 22 Medicare/Medicaid. Financial data was available for 56 patients: average total hospital cost was $49,248 and reimbursement was $63,771, for a hospital profit of $14,523/patient. Despite similar costs between Medicare/Medicaid and private-insurance patients, Medicare/Medicaid reimbursed much less ($30,713 vs $80,747; p < 0.001), resulting in a net loss of $17,342 per patient. For private-insured patients, major complications were associated with increased cost and increased reimbursement, resulting in a net profit of $36,285, compared with a net loss of $54,274 in Medicare/Medicaid patients.
CRS/HIPEC is profitable in privately insured patients, even for those with major complications, but loses money in patients with Medicare/Medicaid. Under a future bundled-reimbursement system, complications will be negatively associated with profit. With these impending changes, hospitals must place emphasis on value, recalculate the reimbursement necessary for financial viability, and focus on decreasing costs and minimizing complications.
尽管细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）的应用越来越广泛，但关于其财务影响的数据却很少。我们在保险供应商类型和术后并发症的背景下分析了医院成本和报销数据。
分析了2009年至2013年在单一机构接受CRS/HIPEC的所有患者的临床病理变量、医院成本和报销情况。
共有64例患者接受了CRS/HIPEC。PCI评分中位数为19，平均手术时间为550分钟。肿瘤组织学类型包括阑尾（n = 40；62%）、结直肠（n = 16；25%）、杯状细胞（n = 5；8%）和间皮瘤（n = 3；5%）。住院时间中位数为13天。42例患者（66%）出现并发症，其中13例（20%）出现严重（Clavien III-IV级）并发症。付费方组合包括42例私人保险患者和22例医疗保险/医疗补助患者。56例患者有财务数据：平均总住院成本为49,248美元，报销金额为63,771美元，医院每例患者盈利14,523美元。尽管医疗保险/医疗补助患者和私人保险患者的成本相似，但医疗保险/医疗补助的报销金额要少得多（30,713美元对80,747美元；p < 0.001），导致每例患者净亏损17,342美元。对于私人保险患者，严重并发症与成本增加和报销增加相关，导致净利润为36,285美元，而医疗保险/医疗补助患者净亏损54,274美元。
CRS/HIPEC在私人保险患者中是盈利的，即使是那些有严重并发症的患者，但在医疗保险/医疗补助患者中会亏损。在未来的捆绑报销系统下，并发症将与利润呈负相关。随着这些即将到来的变化，医院必须重视价值，重新计算财务可行性所需的报销金额，并专注于降低成本和减少并发症。
