Effect of hospital safety-net burden on cost and outcomes after surgery

Abstract

IMPORTANCE Safety-net hospitals provide broad services for a vulnerable population of patients and are financially at risk owing to impending reimbursement penalties and policy changes. OBJECTIVE To determine the effect of patient and hospital factors on surgical outcomes and cost at safety-net hospitals. DESIGN, SETTING, AND PARTICIPANTS Hospitals in the University HealthSystem Consortium database from January 1, 2009, through December 31, 2012 (n = 231), were grouped according to their safety-net burden, defined as the proportion of Medicaid and uninsured patient charges for all hospitalizations during that time (n = 12 638 166). Nine cohorts, based on a variety of surgical procedures, were created and examined with regard to preoperative characteristics, postoperative outcomes, and resource utilization. Multiple logistic regression was performed to analyze the effect of patient and center factors on outcomes. Hospital Compare data from the Centers for Medicare &Medicaid Services were linked and used to characterize and compare the groups of hospitals. MAIN OUTCOMES AND MEASURES Postoperative mortality, 30-day readmissions, and total direct cost. RESULTS For all 9 procedures examined in 231 hospitals comprising 12 638 166 patient encounters, patients at hospitals with high safety-net burden (HBHs) (vs hospitals with low and medium safety-net burdens) were most likely to be young, to be black, to be of the lowest socioeconomic status, and to have the highest severity of illness and the highest cost for surgical care (P