Infection Control & Hospital Epidemiology (2018), 39, 1246–1249 doi:10.1017/ice.2018.179
Concise Communication
Costs versus earnings in colon surgery and coronary artery bypass grafting under a prospective payment system: Sufficient financial incentives to reduce surgical site infections?
Fabrice Juchler MMed1,2,a, Jan A. Roth MD1,2,a, Alexander Schweiger MD2,3, Marc Dangel MPH1,2, Massimo Gugliotta4, Manuel Battegay MD1,2,Friedrich
S.Eckstein MD2,5, Christoph Kettelhack MD2,6, Christian Abshagen MD, MBA4,
Balthasar L. Hug MD, MBA, MPH2,7, John M. Boyce MD8 and Andreas F. Widmer MD, MS1,2,3 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland, 2University of Basel, Basel, Switzerland, 3Swissnoso, National Center for Infection Prevention, Bern, Switzerland, 4Department of Finance, University Hospital Basel, Basel, Switzerland, 5Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland, 6Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland, 7Department of Internal Medicine, Kantonsspital Luzern, Lucerne, Switzerland and 8J.M. Boyce Consulting, LLC, Middletown, Connecticut, United States of America
Abstract
Based on a surgical site infection (SSI) cohort at an academic center, we showed a median potentially preventable loss per non-SSI case of $17,916 in colon surgery and of $34,741 in coronary artery bypass grafting. (Received 16 May 2018; accepted 11 July 2018; electronically published August 22, 2018)
Surgical site infections (SSIs) have a high impact on morbidity, mortality, and healthcare finances, but associated hospital costs and earnings may differ substantially.1 Under the widespread prospective payment system (eg, Centers for Medicare and Medicaid Services), hospital revenues depend on discharge diag- noses and procedures resulting in 1 diagnosis-related group (DRG) code per hospitalization. Higher costs of an SSI could potentially be reimbursed by more profitable DRG codes, miti- gating financial incentives for infection prevention. These costs and earnings were not assessed for routine surgical procedures in a recent cohort.2,3 Under a prospective DRG payment scheme, we aimed to
compare the actual hospital costs and earnings in colon surgery and coronary artery bypass grafting (CABG) patients with and without a subsequent SSI.
Methods
This financial analysis nested within a prospective SSI surveillance cohort was conducted at the University Hospital Basel, a tertiary- care center in Switzerland with 865 beds and >36,000 admissions per year. All consecutive inpatients aged ≥18 years who under- went colon operations between January 1, 2015, and December 31, 2016 and patients who had CABG procedures performed
Author for correspondence: Andreas F. Widmer, MD, MS, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031
Basel, Switzerland. E-mail:
andreas.widmer@usb.ch aAuthors of equal contribution.
Cite this article: Juchler F, et al. (2018). Costs versus earnings in colon surgery and
coronary artery bypass grafting under a prospective payment system: Sufficient financial incentives to reduce surgical site infections?. Infection Control & Hospital Epidemiology 2018, 39, 1246–1249. doi: 10.1017/ice.2018.179
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
between January 1, 2015, and October 31, 2016, were eligible for study inclusion. Both nonelective (emergency) and elective operations were included. Exclusion criteria were (1) missing surveillance data, (2) loss to follow-up, and (3) patients who had >1 unrelated operation during the index hospitalization. The index hospitalization comprised the colon or CABG operation under surveillance. The local ethics committee approved the study as part of a continuing quality improvement program and issued a waiver of informed consent. Surveillance data were prospectively collected by well-
instructed infection practitioners and were validated according to Swissnoso recommendations.4 In brief, infection practitioners are supervised by an infectious diseases specialist and quality of surveillance is evaluated by on-site audits every other year. SSIs were classified according to Centers for Disease Control and Prevention definitions.5 Postdischarge SSI surveillance was con- ducted via standardized phone calls 1 month and 1 year after colon or minimally invasive direct coronary artery bypass operations and CABG, respectively, and by systematically reviewing the electronic medical records. Financial and admin- istrative data were linked on an individual level with the respec- tive surveillance data. Coprimary outcome measures were actual hospital costs and
earnings under a prospective payment system, stratified by SSI status. Earnings were calculated before taxes as the difference between overall inpatient DRG revenues (Swiss DRG) and costs of the index hospitalization and of any hospitalizations during the follow-up period due to subsequent surgical complications and SSIs, as defined by expert consensus (see Supplementary Material). Costs were calculated based on the national standard cost- accounting method.6 Costs included imaging, laboratory tests, medical and treatment services, pharmaceutical products, nursing
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