T. Zander1, M. Kendall1, H. Janjua1, P. Kuo1, E. Grimsley1 1University Of South Florida College Of Medicine, Department Of Surgery, Tampa, FL, USA
Introduction:
The cost-to-charge ratio (CCR) is a metric reflecting the relationship between hospital costs and the charges billed to payors. A lower CCR indicates lower costs and/or higher charges. The impact of CCR on patient outcomes has not been established. This study aims to identify the factors that influence changes in CCR and how these changes impact surgical outcomes.
Methods:
Florida Agency for Healthcare Administration Inpatient database (2018-2020) was queried for patients who underwent hysterectomy, sleeve gastrectomy, gastric bypass, anti-reflux surgery, colectomy, ventral hernia repair, or lobectomy. Surgical approach was noted. The resulting cohort was linked to Distressed Communities Index (DCI), RAND Corporation Hospital data, Center for Medicare Services Cost Reports and Hospital Compare, and American Hospital Association data. Yearly trends in CCR were examined. Hospitals with monotonically increasing CCR were compared to those with decreasing CCR using univariate analysis. Significant factors were used in Gradient Boosting Machine (GBM) models to evaluate the impact of hospital and patient factors on change in CCR.
Results:
The cohort had 146 hospitals. Of those, 67 were included in the analysis – 27 with increasing CCR and 40 with decreasing CCR. 35,661 patients were analyzed from these hospitals. A decreasing CCR was associated with a lower average CCR (0.12 ± 0.06 vs 0.19 ± 0.08, p<0.01) as well as higher net incomes (p=0.02). Decreasing CCR hospitals were more often teaching hospitals (p=0.02) or for-profit (p=0.01). Patients from hospitals with decreasing CCR had higher mean total charges ($134,349 ± $114,510 vs $77,185 ± $82,027, p<0.01) with marginally higher mean costs ($14,863 ± $12,343 vs $14,458 ± $15,440, p<0.01). Patients from decreasing CCR hospitals had higher rates of comorbidities but no significant difference in overall complications. Hospital-factor GBM indicated total inpatient charges, movable equipment assets, and salary expenses were the most influential variables over CCR (model accuracy 83%). Patient-factor GBM indicated total charges, room charges, and type of procedure were most influential over CCR (model accuracy 74%).
Conclusion:
Decreasing CCR was associated with proprietary ownership and better financial performance. Hospitals with decreasing CCR charge more despite only a minimal increase in estimated surgical costs and no difference in overall complications. Despite increasing charges, hospitals with decreasing CCR do not offer superior patient outcomes. GBM modeling revealed that hospital financials are the principal factors in decreasing CCR. Patient factors have far less of an impact. Future studies may examine the factors most influential in surgical charges.