Original scientific articleWho Pays for Poor Surgical Quality? Building a Business Case for Quality Improvement
Section snippets
Study overview and data sources
We merged clinical information from the National Surgical Quality Improvement Program’s private-sector database to the internal accounting data available at the University of Michigan hospital. Only patients enrolled in the National Surgical Quality Improvement Program at this single university center during a 2-year period between January 1, 2001, and December 31, 2002, were included. Consistent with published methodology, the sample of surgical patients included the first 40 consecutive adult
Results
The financial burden absorbed by the hospital is best represented by changes in profits and profit margins when complications occur (Table 1). Mean reimbursement for patients without complications ($14,266) exceeded hospital costs ($10,978), generating an average hospital profit of $3,288 (23% profit margin). When complications occurred, hospitals still received enough reimbursement to cover their costs. Mean reimbursement for patients with complications ($21,911) exceeded mean hospital costs
Discussion
Although payors and hospitals both suffer financial consequences relating to poor-quality care, payors appear to bear a larger burden of the costs. When surgical complications occur, hospitals experience a decline in profits and profit margin per case, but reimbursement usually covers their costs. In contrast, payors always lose money with complications: reimbursement increases an average of 54% when complications occur. Health-care payors clearly have a large stake in ensuring the success of
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Competing Interests Declared: None.
Dr Dimick was supported by a Veterans Affairs Special Fellowship Program in Outcomes Research. The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the federal government.