Effect of hospital safety-net burden on surgical costs, outcomes

Safety-net hospitals provide services for a vulnerable population of patients and are financially at risk because of government reimbursement penalties and policy changes.

Researchers at the University of Cincinnati School of Medicine examined the effect of patient and hospital factors on surgical outcomes and costs at safety-net hospitals. They investigated nine procedures performed in 231 hospitals comprising nearly 13 million patients. The nine cohorts were evaluated with regard to preoperative characteristics, postoperative outcomes, and resource utilization.

After adjusting for patient characteristics and center volume, the researchers found that high safety-net burden hospitals had:

• higher odds of mortality for three procedures
• higher odds of readmission for two procedures
• the highest cost of care for seven of the nine procedures.

High safety-net burden hospitals also had inferior performance on Surgical Care Improvement Project measures, higher rates of surgical complications, and inferior markers of emergency department timeliness and efficiency.

The data suggest that intrinsic qualities of safety-net hospitals and not necessarily patient factors lead to inferior surgical outcomes and increased costs. Reimbursement penalties based on performance measures may have a negative effect on surgical care at these centers, the researchers say.

—Hoehn R S, Wima K, Vestal M A, et al. Effect of hospital safety-net burden on cost and outcomes after surgery. JAMA Surg. Published online October 14, 2015.

—http://archsurg.jamanetwork.com/article.aspx?articleid=2456118