Surgical Warranties to Improve Quality and Efficiency in Elective Colon Surgery

BACKGROUND Uncomplicated surgical care has highly variable costs. High costs of complications have led payers to deny additional payments even for predictable complications. HYPOTHESIS A payment warranty indexed to effective and efficient hospitals can promote quality and economic stewardship in sur...

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Veröffentlicht in:Archives of surgery (Chicago. 1960) 2010-07, Vol.145 (7), p.647-652
Hauptverfasser: Fry, Donald E, Pine, Michael, Jones, Barbara L, Meimban, Roger J
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container_end_page 652
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container_title Archives of surgery (Chicago. 1960)
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creator Fry, Donald E
Pine, Michael
Jones, Barbara L
Meimban, Roger J
description BACKGROUND Uncomplicated surgical care has highly variable costs. High costs of complications have led payers to deny additional payments even for predictable complications. HYPOTHESIS A payment warranty indexed to effective and efficient hospitals can promote quality and economic stewardship in surgical care. DESIGN Analysis of hospital costs for elective colon surgery in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2002 through 2005. SETTING A 20% sample of acute care hospitals in the United States. PATIENTS AND METHODS Data for elective colon resections were used to create predictive models for adverse outcomes (AOs) and costs. Total hospital costs were determined using cost-to-charge ratios. Costs of AOs were computed as total costs minus predicted costs of uncomplicated care. Surgical warranties were computed as the probability of AOs times per-case predicted costs of AOs. Final predictive models were calibrated using data only from effective and efficient hospitals. RESULTS We studied 51 602 cases from 632 hospitals. There were 4048 (7.8%) AOs with 505 deaths (1.0%); 19 hospitals had excessive AOs and 95 hospitals had excessive costs. For 518 effective and efficient hospitals, total per-case costs for routine care were $9843 with an average warranty of $1294 and a $276 stop-loss allocation. This cost model would reduce national expenditures for colon surgery by 6%. CONCLUSIONS Complications and costs of care can be indexed to quality performing hospitals. Warranties for surgical care can reward effective and efficient care and preclude the need for additional payments for complications.Arch Surg. 2010;145(7):647-652-->
doi_str_mv 10.1001/archsurg.2010.106
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High costs of complications have led payers to deny additional payments even for predictable complications. HYPOTHESIS A payment warranty indexed to effective and efficient hospitals can promote quality and economic stewardship in surgical care. DESIGN Analysis of hospital costs for elective colon surgery in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2002 through 2005. SETTING A 20% sample of acute care hospitals in the United States. PATIENTS AND METHODS Data for elective colon resections were used to create predictive models for adverse outcomes (AOs) and costs. Total hospital costs were determined using cost-to-charge ratios. Costs of AOs were computed as total costs minus predicted costs of uncomplicated care. Surgical warranties were computed as the probability of AOs times per-case predicted costs of AOs. Final predictive models were calibrated using data only from effective and efficient hospitals. RESULTS We studied 51 602 cases from 632 hospitals. There were 4048 (7.8%) AOs with 505 deaths (1.0%); 19 hospitals had excessive AOs and 95 hospitals had excessive costs. For 518 effective and efficient hospitals, total per-case costs for routine care were $9843 with an average warranty of $1294 and a $276 stop-loss allocation. This cost model would reduce national expenditures for colon surgery by 6%. CONCLUSIONS Complications and costs of care can be indexed to quality performing hospitals. Warranties for surgical care can reward effective and efficient care and preclude the need for additional payments for complications.Arch Surg. 2010;145(7):647-652--&gt;</description><identifier>ISSN: 0004-0010</identifier><identifier>ISSN: 2168-6254</identifier><identifier>EISSN: 1538-3644</identifier><identifier>EISSN: 2168-6262</identifier><identifier>DOI: 10.1001/archsurg.2010.106</identifier><identifier>PMID: 20644127</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Colectomy - adverse effects ; Colectomy - economics ; Colectomy - mortality ; Colorectal surgery ; Economics, Hospital ; Elective Surgical Procedures - economics ; Health Care Reform ; Hospital Costs ; Humans ; Insurance Claim Review ; Insurance, Health - economics ; Insurance, Health - trends ; Length of Stay - economics ; Models, Economic ; Payments ; Prospective Payment System - economics ; Quality of care ; Surgical outcomes ; United States ; Warranties</subject><ispartof>Archives of surgery (Chicago. 1960), 2010-07, Vol.145 (7), p.647-652</ispartof><rights>Copyright American Medical Association Jul 2010</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a345t-1420e47d318d53bdbd6db8547e1e16490ed06fb635330a6fecb9679a04fb24693</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/archsurg.2010.106$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.2010.106$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20644127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fry, Donald E</creatorcontrib><creatorcontrib>Pine, Michael</creatorcontrib><creatorcontrib>Jones, Barbara L</creatorcontrib><creatorcontrib>Meimban, Roger J</creatorcontrib><title>Surgical Warranties to Improve Quality and Efficiency in Elective Colon Surgery</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>Arch Surg</addtitle><description>BACKGROUND Uncomplicated surgical care has highly variable costs. High costs of complications have led payers to deny additional payments even for predictable complications. HYPOTHESIS A payment warranty indexed to effective and efficient hospitals can promote quality and economic stewardship in surgical care. DESIGN Analysis of hospital costs for elective colon surgery in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2002 through 2005. SETTING A 20% sample of acute care hospitals in the United States. PATIENTS AND METHODS Data for elective colon resections were used to create predictive models for adverse outcomes (AOs) and costs. Total hospital costs were determined using cost-to-charge ratios. Costs of AOs were computed as total costs minus predicted costs of uncomplicated care. Surgical warranties were computed as the probability of AOs times per-case predicted costs of AOs. Final predictive models were calibrated using data only from effective and efficient hospitals. RESULTS We studied 51 602 cases from 632 hospitals. There were 4048 (7.8%) AOs with 505 deaths (1.0%); 19 hospitals had excessive AOs and 95 hospitals had excessive costs. For 518 effective and efficient hospitals, total per-case costs for routine care were $9843 with an average warranty of $1294 and a $276 stop-loss allocation. This cost model would reduce national expenditures for colon surgery by 6%. CONCLUSIONS Complications and costs of care can be indexed to quality performing hospitals. 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subjects Colectomy - adverse effects
Colectomy - economics
Colectomy - mortality
Colorectal surgery
Economics, Hospital
Elective Surgical Procedures - economics
Health Care Reform
Hospital Costs
Humans
Insurance Claim Review
Insurance, Health - economics
Insurance, Health - trends
Length of Stay - economics
Models, Economic
Payments
Prospective Payment System - economics
Quality of care
Surgical outcomes
United States
Warranties
title Surgical Warranties to Improve Quality and Efficiency in Elective Colon Surgery
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