title: The Association Between Hospital Finances and Complications After Complex Abdominal Surgery: Deficiencies in the Current Health Care Reimbursement System and Implications for the Future.
abstract: OBJECTIVE
  To determine the relationship between complications after 3 common general surgery procedures and per-episode hospital finances.
  
  
  BACKGROUND
  With impending changes in health care reimbursement, maximizing the value of care delivered is paramount. Data on the relative clinical and financial impact of postoperative complications are necessary for directing surgical quality improvement efforts.
  
  
  METHODS
  We reviewed the medical records of patients enrolled in the American College of Surgeons' National Surgical Quality Improvement Program who underwent pancreaticoduodenectomy, hepatectomy, and colectomy at a single academic institution between September 2009 and August 2012. Clinical outcomes data were subsequently linked with hospital billing data to determine hospital finances associated with each episode. We describe the association between postoperative complications, hospital length of stay, and different financial metrics. Multivariable linear regression modeling tested linear association between postoperative outcomes and cost data.
  
  
  RESULTS
  There was a positive association between the number of surgical complications, payments, length of stay, total charges, total costs, and contribution margin for the three procedures. Multivariable models indicated that complications were independently associated with total cost among the selected procedures. Payments increased with complications, offsetting increased costs.
  
  
  CONCLUSIONS
  In the current fee-for-service environment, the financial incentives are misaligned with quality improvement efforts. As we move to a value-driven method of reimbursement, administrators and health care providers alike will need to focus on improving the quality of patient care while remaining conscious of the cost of care delivered. Reducing complications effectively improves value.
authors.affiliation: *Department of Surgery Patient Safety and Data Management Program, Emory University School of Medicine, Atlanta, GA †Division of General and Gastrointestinal Surgery, Emory University School of Medicine, Atlanta, GA ‡Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA §Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA ¶Division of Transplantation, Emory University School of Medicine, Atlanta, GA.
authors.forename: William S
authors.initials: WS
authors.lastname: Knechtle
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Perez
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Medbery
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Gartland
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: Virginia O
authors.initials: VO
authors.lastname: Shaffer
authors.forename: Jahnavi K
authors.initials: JK
authors.lastname: Srinivasan
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects* / Q000191:economics; D004469:Economics, Hospital; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000191:economics; D058996:Quality Improvement / Q000458:organization & administration*; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D012189:Retrospective Studies; D014481:United States