Hoskins Nathanael N, Cunicelli Marco A, Hopper Wade, Zeller Robert, Cheng Ning, Lindsey Tom
Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA.
Surgery, Edward Via College of Osteopathic Medicine, Spartanburg, USA.
Cureus. 2021 Apr 8;13(4):e14367. doi: 10.7759/cureus.14367.
Purpose Critical Access Hospitals (CAHs) serve rural populations and receive government subsidies to compensate for their relatively high overhead costs and low occupancy rates. Twenty-nine percent of all hospitalizations in the United States include a surgical procedure, and hospitalizations involving surgery accounted for nearly half of all hospital revenue in 2011. This study aims to determine the value surgical services bring to CAHs and their impact on the viability of these facilities. Methods Public access data from the American Hospital Directory (AHD) was analyzed about each hospital's revenue and surgical services offered. Excel was utilized to randomly select 300 CAHs from a pool of 1350 CAHs based on a 95% confidence interval and a 5% margin of error. Linear regression models were fit to the data evaluating the association of net income with the number of surgical services offered per hospital and the association of total margin with the number of surgical services offered per hospital. Models were adjusted for location, occupancy rate, and case mix index. Findings The linear regression model demonstrated that for every additional surgical service provided by a CAH, the hospital net income increased by $630,528 (p=0.0032). A similar trend was observed when modeling profitability. The total margin increased 0.73% for each additional surgical service added, albeit without statistical significance (p=0.1342). CAHs providing two or three surgical services showed tighter group variance than those not offering surgery or only offering one surgical service. Conclusions Net income was significantly correlated to the number of surgical services offered at CAHs. Furthermore, CAHs offering more surgical services seem to have more predictable profits than those offering less surgical services. CAHs would financially benefit from offering more or expanding surgical services at their facilities.
目的 临界接入医院（CAHs）为农村人口提供服务，并接受政府补贴以补偿其相对较高的间接费用和低入住率。在美国，29%的住院治疗包括外科手术，2011年涉及手术的住院治疗占所有医院收入的近一半。本研究旨在确定外科服务给临界接入医院带来的价值及其对这些机构生存能力的影响。 方法 分析了美国医院目录（AHD）中的公共访问数据，内容涉及每家医院的收入和提供的外科服务。利用Excel从1350家临界接入医院中基于95%的置信区间和5%的误差幅度随机选择300家。将线性回归模型应用于数据，评估每家医院净收入与提供的外科服务数量之间的关联以及总利润率与每家医院提供的外科服务数量之间的关联。模型针对地理位置、入住率和病例组合指数进行了调整。 结果 线性回归模型表明，临界接入医院每增加一项外科服务，医院净收入增加630,528美元（p = 0.0032）。在对盈利能力进行建模时也观察到了类似趋势。每增加一项外科服务，总利润率增加0.73%，尽管无统计学意义（p = 0.1342）。提供两项或三项外科服务的临界接入医院比不提供手术或仅提供一项外科服务的医院表现出更紧密的组内方差。 结论 净收入与临界接入医院提供的外科服务数量显著相关。此外，提供更多外科服务的临界接入医院似乎比提供较少外科服务的医院利润更可预测。临界接入医院通过在其机构提供更多或扩大外科服务将在财务上受益。
