Drivers of Hospital Financial Performance and Patient Outcomes in Cushing Disease

Introduction: Transsphenoidal adenomectomy for Cushing's disease (CD) is an independent driver of high inpatient healthcare costs compared with transsphenoidal surgery for other pituitary tumors because of their longer length of stay and comorbidities. Understanding the financial performance of CD surgery is essential to prepare for a future in value-based care. Key aspects of the CD care pathway at our center include tumor pseudocapsule resection, when possible; regular serum cortisol checks; and glucocorticoid supplementation for serum levels less than 3.0 µg/dL, opioid-sparing pain control, and early mobilization. Herein, we investigate the predictors of hospital financial performance during the surgical epoch for Cushing's disease.

Methods: To evaluate drivers of hospital financial performance, all patients undergoing elective transsphenoidal surgery for Cushing's disease between 2015 and 2019 at a single institution were reviewed. Per-patient net revenue, cost, profit, and contribution margin were evaluated. Predictors of resource utilization were examined using standard statistical techniques.

Results: Sixty-seven patients who underwent transsphenoidal surgery for Cushing's disease were included in the study. Mean per-patient hospital net revenue was $46,586 ± $25,165 and per-patient hospital profit was $23,892 ± $22,455. Length of stay less than 2 midnights was associated with a significantly lower per-patient hospital cost ($18,398 ± $1,733 for LOS ≤ 2; $28,324 ± $16,527 for LOS > 2, p < 0.005), increased per-patient profit ($29,612 ± $21,363 for LOS ≤ 2; $16,397 ± $21,975 for LOS > 2, p < 0.005) and higher per-patient contribution margins ($37,823 ± $21,506 for LOS ≤ 2; $28,362 ± $23,519 for LOS > 2, p < 0.05) compared with patients with length of stay greater than 2 midnights. Financial performance was superior for patients with commercial versus government (Medicare and Medicaid) payers, with higher per-patient net revenue ($54,647 ± $15,508 vs. $22,879 ± $31,817, p < 0.001), increased per-patient profit ($32,908 ± 17,170 vs. −2,626 ± 12,866, p < 0.001) and larger per-patient contribution margins (42,440 ± 16,160 vs. 8,103 ± 19,280, p < 0.001).

Conclusion: These findings suggest the surgical treatment of Cushing's disease to be a profitable service line at a high-volume center despite the challenging nature of CD patients. Length of stay and payer mix remain significant drivers of financial performance, underscoring the importance of comprehensive quality improvement efforts that decrease the former and optimize healthcare value.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
01 February 2023