title: Impact of Surgical Quality Improvement on Payments in Medicare Patients.
abstract: OBJECTIVE
  To examine the financial impact of quality improvement using Medicare payment data.
  
  
  BACKGROUND
  Demonstrating a business case for quality improvement--that is, that fewer complications translates into lower costs--is essential to justify investment in quality improvement. Prior research is limited to cross-sectional studies showing that patients with complications have higher costs. We designed a study to better evaluate the relationship between payments and complications by using quality improvement itself as a measured outcome.
  
  
  METHODS
  We used national Medicare data for patients undergoing general (n = 1,485,667) and vascular (n = 531,951) procedures. We calculated hospitals' rates of serious complications in 2 time periods: 2003-2004 and 2009-2010. We sorted hospitals into quintiles by the change in complication rates across these time periods. Costs were assessed using price-standardized Medicare payments, and regression analyses used to determine the average change in payments over time.
  
  
  RESULTS
  There was significant change in serious complication rates across the 2 time periods. The top 20% of hospitals demonstrated a 38% decrease (14.3% vs 11.6%, P < 0.001) in complications; in contrast the bottom 20% demonstrated a 25% increase (11.1% vs 16.5%, P < 0.001). There was a strong relationship between quality improvement and payments. The top hospitals reduced their payments by $1544 per patient (95% confidence interval: $1334-1755), whereas the bottom of hospitals had no significant change (average $67 increase, 95% confidence interval: -$123 to $258).
  
  
  CONCLUSIONS
  Hospitals that reduced their complications over time had significant reductions in Medicare payments. This demonstrates that payers are clearly incentivized to invest in quality improvement.
authors.affiliation: University of Michigan, Department of Surgery, Center for Healthcare Outcomes and Policy, Ann Arbor, MI.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Scally
authors.forename: Jyothi R
authors.initials: JR
authors.lastname: Thumma
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000191:economics*; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data