Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery

Liam O'Neill, Franklin Dexter, Sae Hwan Park, Richard H. Epstein

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Abstract

Study Objective Most 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. Design Observational study. Setting State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. Patients Inpatients discharged with a major therapeutic (“operative”) procedure. Measurements For 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 results Major 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. Conclusions Approximately 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.

Original languageEnglish
Pages (from-to)99-103
Number of pages5
JournalJournal of Clinical Anesthesia
Volume41
DOIs
StatePublished - 1 Sep 2017

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Hospital Costs
Inpatients
Diagnosis-Related Groups
Costs and Cost Analysis
Weights and Measures
State Hospitals
Operative Surgical Procedures
International Classification of Diseases
Observational Studies
Length of Stay

Cite this

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title = "Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery",
abstract = "Study Objective Most 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. Design Observational study. Setting State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. Patients Inpatients discharged with a major therapeutic (“operative”) procedure. Measurements For 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 results Major 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. Conclusions Approximately 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.",
author = "Liam O'Neill and Franklin Dexter and Park, {Sae Hwan} and Epstein, {Richard H.}",
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Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery. / O'Neill, Liam; Dexter, Franklin; Park, Sae Hwan; Epstein, Richard H.

In: Journal of Clinical Anesthesia, Vol. 41, 01.09.2017, p. 99-103.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery

AU - O'Neill, Liam

AU - Dexter, Franklin

AU - Park, Sae Hwan

AU - Epstein, Richard H.

PY - 2017/9/1

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N2 - Study Objective Most 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. Design Observational study. Setting State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. Patients Inpatients discharged with a major therapeutic (“operative”) procedure. Measurements For 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 results Major 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. Conclusions Approximately 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.

AB - Study Objective Most 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. Design Observational study. Setting State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. Patients Inpatients discharged with a major therapeutic (“operative”) procedure. Measurements For 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 results Major 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. Conclusions Approximately 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.

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JO - Journal of Clinical Anesthesia

JF - Journal of Clinical Anesthesia

SN - 0952-8180

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