Hospitals profit $40,000 for some patients with complications

April 17, 2013 at 11:21 AM
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BOSTON, April 17 (UPI) -- Privately insured patients in U.S. hospitals who suffered surgical complications delivered almost $40,000 more in profit per patient, researchers found.

Dr. Sunil Eappen of Harvard Medical School in Boston and colleagues measured the financial implications associated with post-surgical complications of nearly 35,000 surgical discharges from a 12-hospital system.

Nine common surgical procedures and 10 major complications across four payer types -- Medicare, private insurance, Medicaid and self-pay -- were analyzed.

Of the 34,256 surgical discharges, 5.3 percent, experienced one or more post surgical complications, the study found.

The study, published in the Journal of the American Medical Association, found the occurrence of one or more complications was associated with higher hospital costs in all payer types, but how much more hospital revenue collected depended by payer type.

Patients experiencing one or more complications had a profit margin of $39,017 per patient with private insurance versus privately insured patients who had no complications. Hospitals with patients on Medicare collected about $1,700 more per patient than those with no complications, the study also found.

However, Medicaid patients or those who paid for their own surgery and hospitalization accounted for only about 10 percent of the patients studied, the researchers say.

"Those on Medicaid and self-pay procedures, with complications were associated with significantly lower contribution margins than those without complications," the researchers said.

"Most U.S. hospitals treat patient populations primarily covered by Medicare or private payers, and programs to reduce complications may worsen their near-term financial performance."

Effective methods for reducing surgical complications have been identified. but hospitals have been slow to implement them, the researchers said.

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