title: Hospital resources are associated with value-based surgical performance.
abstract: We have previously shown that inferior outcomes at safety-net hospitals are largely dependent on hospital factors. We hypothesized that hospitals providing "high value" care (low cost and better outcomes) would have advantages in human and financial resources.
  
  
  
  The University HealthSystems Consortium Clinical Database and the American Hospital Association Annual Survey were used to examine hospitals performing eight complex surgical procedures from 2009 to 2013. Hospitals in the lowest quartiles of both mortality rate and cost were characterized as high value (n = 45), whereas those in the highest quartiles of both cost and mortality were low value (n = 45). Hospital size, staffing, and financial characteristics were compared between these two groups.
  
  
  
  On average, high-value hospitals had lower proportions of Medicaid patient days (17% versus 30%; P < 0.01), higher proportions of outpatient surgery (63% versus 53%; P < 0.01), and spent more on capital expenditures per bed ($155,710 versus $62,434; P < 0.05). Also, high-value hospitals employed more hospitalists (0.08 versus 0.04 per bed; P < 0.01), had more privileged physicians (2.04 versus 1.25 per bed; P < 0.01), and had more full-time equivalent personnel (8.48 versus 6.79 per bed; all P < 0.05). As a result, these hospitals appeared to be more efficient; high-value hospitals had more total admissions per bed (46 versus 38; P < 0.01), fewer days per admission (5.20 versus 5.77; P < 0.01), and more inpatient surgeries per bed (15.7 versus 12.6; all P < 0.05).
  
  
  
  Hospitals that invest in more human resources and demonstrate increased throughput perform complex surgery at higher "value" (i.e., lower costs and mortality). Value-based purchasing initiatives that link hospital reimbursement to unadjusted surgical outcomes may exacerbate, rather than improve, disparities in surgical care that currently exist.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Derek
authors.initials: D
authors.lastname: Go
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Alex
authors.initials: A
authors.lastname: Chang
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Ertel
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio. Electronic address: abbottdl@ucmail.uc.edu.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
mesh_terms: D019985:Benchmarking; D016208:Databases, Factual; D017598:Efficiency, Organizational; D005260:Female; D019538:Health Care Surveys; D006295:Health Resources; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D064876:Safety-net Providers / Q000592:standards; D013514:Surgical Procedures, Operative / Q000191:economics / Q000401:mortality / Q000592:standards*; D014481:United States
keywords: Hospital resources; Policy; Reimbursement; Surgical outcomes