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Impact of Surgical Quality Improvement on Payments in Medicare Patients
- Publication Year :
- 2015
-
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.
- Subjects :
- Male
medicine.medical_specialty
Quality management
media_common.quotation_subject
Medicare
Article
Medicine
Humans
health care economics and organizations
Digestive System Surgical Procedures
media_common
Aged
Aged, 80 and over
business.industry
Financial impact
Surgical procedures
Payment
Quality Improvement
Confidence interval
United States
Acs nsqip
Medicare payment
Emergency medicine
Surgery
Female
Health Expenditures
Complication
business
Vascular Surgical Procedures
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....ec99f34e09d8149501375e4d29776e54