I am the newly appointed hospital administrator of a small, rural community. We are the only hospital in this area and draw patients from over 300 miles away. Sometimes I see you report on how other health care facilities are working to improve things. So I'm trolling for information to find out what might be out there to help me reduce costs within our organization.
We recently reported on a study performed at the University of Pennsylvania in Philadelpia about the cost of complications and comorbidities associated with spinal surgeries. With more and more people seeking health care for back problems, this seemed like an easy one to spot and bring to the attention of everyone interested in reducing health care costs.
The authors start out with the basic proposition that many people in need of spinal surgery also suffer from other health problems such as high blood pressure, diabetes, cancer, obesity, neurologic problems and many others. As you know, these additional conditions are referred to as comorbidities. Patients often have more than one comorbidity. And then there are the complications that can occur after surgery. Comorbidities and complications take their toll on patients but can also add quite a bit to the hospital bill and cost of health care overall.
Data on 226 patients undergoing spinal surgery for a variety of reasons was collected. Age, sex (male or female), body mass index (BMI, an indicator of obesity), number and type of comorbidities, type of procedure, and type and number of complications were reported and analyzed. The researchers determined which problems are the most significant but also looked at the costs.
They found that although high blood pressure (hypertension) was the most common comorbidity, the problems that caused the most difficulty were pulmonary (blood clots, pneumonia), improper positioning of hardware used in spinal fusions, new neurologic problem (caused by the surgery), and wound infection.
Costs started escalating when a problem developed as a result of being in the hospital. This is referred to as a hospital-acquired condition or HAC, a concept you are probably very familiar with. Those additional costs spiraled upwards as complications increased in number or severity. Longer hospital stays required more care and greater use of resources. The result was an increase in the cost to insurance companies (or payers like Medicare). When the costs were greater than the reimbursement, then hospitals took a financial hit, too.
The question arises: should patients with multiple health problems be refused surgery? This study actually shows that the majority of problems were caused by the hospitalization and/or the surgery itself. And many of the problems required an additional surgery further raising costs associated with hospital acquired conditions.
What can be done to change all this? The authors do not offer any immediate solutions. They suggest the move to electronic medical records will make it possible to track costs and risk factors more closely. Likewise, any interventions applied to the problem can be analyzed to find the most efficient and effective course of action for each problem.
Being able to identify patients at risk and predict the likelihood of a complication may help target those patients for prevention. As this study shows, much of the burden for change lies with improving internal measures (e.g., surgeon technique, hospital care) to reduce complications (and thereby costs).