• Liam O'Neill, Franklin Dexter, Sae-Hwan Park, and Richard H Epstein.
• Department of Health Behavior and Health Systems, School of Public Health, University of North Texas - Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, United States. Electronic address: liam.oneill@unthsc.edu.
• J Clin Anesth. 2017 Sep 1; 41: 99-103.

Study ObjectiveMost surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital.DesignObservational study.SettingState of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016.PatientsInpatients discharged with a major therapeutic ("operative") procedure.MeasurementsFor each of N=343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month.Main ResultsMajor procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (P<0.00001). Average percentage differences were insensitive to the endpoint, with similar results for the percentage of patient days and percentage of DRG case-mix weights.ConclusionsApproximately 2/3rd (mean 68%) of inpatient costs among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them.Copyright © 2017 Elsevier Inc. All rights reserved.

21 keywords...

hide…