Surgical warranties to improve quality and efficiency in elective colon surgery

Archives of Surgery
Donald E FryRoger J Meimban

Abstract

Uncomplicated surgical care has highly variable costs. High costs of complications have led payers to deny additional payments even for predictable complications. A payment warranty indexed to effective and efficient hospitals can promote quality and economic stewardship in surgical care. Analysis of hospital costs for elective colon surgery in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2002 through 2005. A 20% sample of acute care hospitals in the United States. 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. 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 $1...Continue Reading

Citations

Dec 7, 2011·Surgical Infections·Donald E Fry
Feb 18, 2016·Surgical Infections·Donald E Fry
Mar 4, 2014·American Journal of Surgery·Theodor AsgeirssonAnthony J Senagore
Jan 15, 2014·American Journal of Surgery·Donald E FryGregory Pine
Mar 9, 2012·Journal of the American College of Surgeons·Adrian T BilleterSusan Galandiuk
Dec 31, 2011·American Journal of Surgery·Donald E FryRoger J Meimban
Jan 15, 2016·American Journal of Surgery·Donald E FryGregory Pine
Mar 15, 2011·Journal of the American College of Surgeons·Donald E FryRoger J Meimban
Mar 29, 2012·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Dympna M KellyMichael W Kattan
Mar 4, 2011·American Journal of Surgery·Donald E FryRoger J Meimban
Jun 2, 2015·Journal of the American College of Surgeons·Donald E FryGregory Pine
Dec 23, 2014·Journal of the American College of Surgeons·Anne M SteyClifford Y Ko
Oct 1, 2011·The Journal of Thoracic and Cardiovascular Surgery·Donald E FryRoger J Meimban
Jun 1, 2016·American Journal of Surgery·Donald E FryGregory Pine
Feb 27, 2016·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Michael PineBarbara A Dennison
Jan 7, 2017·The Journal of Bone and Joint Surgery. American Volume·Donald E FryGregory Pine
Sep 29, 2011·Annals of Surgery·Kirby I BlandJohn E Niederhuber
Mar 19, 2019·JB & JS Open Access·John M ReuterRichard C Mather

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