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DOI: 10.1055/s-0042-1743764
The Impact of Reducing Unplanned Readmissions Following Elective Pituitary Surgery on Hospital Financial Performance in a Fee-for-Service Payer Environment: Experience of a United States Pituitary Center
Authors
Introduction: Reducing unplanned readmissions after surgery is in important patient safety goal. We and others have achieved significant reductions in readmission rates by instituting evidenced-based standardized care pathways applying common quality principles. In a fee-for-service contracting model, where hospitals bill payers for not only the index surgery, but also for the unplanned readmission, the financial implications for the hospital of this reduction in readmissions have not been explored. To address this knowledge gap, we reviewed hospital financial performance for a cohort of patients readmitted within 30 days after surgery.
Methods: Elective adult patients with pituitary lesions treated with transsphenoidal surgery at a single institution in the United States pituitary center between January 2015 and December 2019 were evaluated. Patient demographics, outcomes, and financial data were collected. Data were analyzed using standard statistical methodology.
Results: A total of 609 adult patients with pituitary tumors were treated with elective transsphenoidal surgery during the audit period. The 30-day unplanned hospital readmission rate decreased to 2.8% in 2019 from 8.3% in 2015. The most common reasons were delayed hyponatremia (n = 17) and epistaxis (n = 10), though hyponatremia declined markedly after instituting prophylactic fluid restriction. All patients were treated in fee-for-service contracting model. 22/38 (57.9%) readmitted patients were covered by commercial insurance, and 15/38 (39.5%) had a government payer. 1/38 patient was uninsured (2.6%). For the readmission inpatient epoch, the mean hospital contribution margin and net income per patient were $6,026 ± 12,903 and $1,906 ± 13,326, respectively. 23/38 (60.5%) readmits were profitable. Total contribution margin and net income from pituitary surgery readmissions in the 2015–2017 epoch was $29,429 and $144,326, respectively, compared with $42,995 and $84,678 in the epoch 2018–2019. The most profitable readmissions were patients with commercial payers (18/22, 81.8%), whereas patients with Medicaid plans were less likely to be profitable (5/15, 33.3%) (P=.005). 12/17 (70.6%) patients readmitted for delayed hyponatremia were profitable.
Conclusion: We are the first to examine the hospital financial implications of reducing readmission rates following elective transsphenoidal pituitary surgery in a fee-for-service payment model. We discovered that, on average, readmitted patients are profitable for the hospital, but it depends on the cause of readmission and payer type. We also learned that the financial impact of reducing unplanned readmissions to the medical center is modest resulting in only a $60,000 decrease in contribution margin in the final two years of study compared with the first three years of study even though there were significantly fewer readmitted patients. At-risk and bundled payment arrangements between providers and payers would better align patient safety goals with hospital financial incentives. However, reducing unplanned admits opens hospital beds for more profitable elective surgery patients.
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Artikel online veröffentlicht:
15. Februar 2022
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