Implications of reimbursement for postop complications on quality, value

Editor's Note

Postoperative complications add an important marginal cost to Medicare payments and lead to a substantial portion of payments to hospitals, this study finds.

Analyzing Medicare data for three procedures from 2009 to 2012, payments per uncomplicated surgical procedure were $13,500 for colectomy, $12,300 for total knee arthroplasty, and $7,300 for carotid endarterectomy.

Payments increased per complication at a rate of $10,996 for colectomy, $13,732 for total knee, and $8,435 for carotid endarterectomy.

The most expensive complication was prolonged ventilation, which increased payment by about $14,100 for colectomy and $6,700 for carotid endarterectomy.

Hospital marginal costs accounting for complication rates added amounts ranging from 0.82% to 9.2%.

Coordinating financial incentives for both payers and providers is needed to improve the delivery of high-quality care to surgical patients, the authors say.

As the current healthcare structure moves toward value-based purchasing, it is helpful for stakeholders to understand costs, particularly for those associated with postoperative complications. The objectives of this study were to assess hospital reimbursements for postoperative complications and generate insight into sustainability of quality.