R. S. Hoehn1, D. J. Hanseman1, D. Go1, K. Wima1, A. L. Chang1, A. E. Ertel1, S. A. Shah1, D. E. Abbott1 1University Of Cincinnati,Surgery,Cincinnati, OH, USA
Introduction: We have previously shown that inferior outcomes at safety-net hospitals are largely dependent on hospital factors. We hypothesized that variation in surgical outcomes is associated with differences in hospital financial and human resource capabilities.
Methods: The University HealthSystems Consortium Clinical Database and the American Hospital Association Annual Survey were used to examine hospitals performing 8 complex surgical procedures from 2009-2013. After excluding centers performing fewer than 10 procedures during the study period, between 66 and 166 centers were included in each procedure analysis. Hospitals in the lowest quartiles of both mortality rate and cost were characterized as high-performing (n=45), and hospitals in the highest quartiles of cost and mortality as low-performing (n=45) (Figure 1). High-performing hospitals for one procedure were never low-performing for another procedure.
Results: On average, high-performing hospitals had lower proportions of Medicaid patient days (17.5% vs 29.7%; p<0.01), higher proportions of outpatient surgery (62.9% vs 53.3%), and spent more on capital expenditures per bed ($155,710 vs $62,434; p<0.05). Also, high-performing hospitals employed more hospitalists (0.08 vs 0.04 per bed), had more privileged physicians (2.03 vs 1.25 per bed), and had more full-time equivalent personnel (8.48 vs 6.79 per bed; all p<0.05). As a result, these hospitals appeared to be more efficient; high-performers had more total admissions per bed (45.8 vs 38.4), fewer days per admission (5.20 vs 5.77), and more inpatient surgeries per bed (15.7 vs 12.6; all p<0.05).
Conclusion: High-performing hospitals invest in more human resources and demonstrate increased throughput compared to low-performing hospitals. Linking hospital reimbursement to outcomes and value-based purchasing may exacerbate, rather than improve, disparities in surgical care that currently exist.
