Circ: Hospitals that perform more, spend more
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“The costs of healthcare are at the center of national attention,” wrote Serene I. Chen, AB, of the Yale University School of Medicine in New Haven, Conn., and colleagues. “A particular focus has been on hospital care, which was estimated to cost $800 billion in 2010 and to represent approximately one third of total healthcare costs.”
To better understand the variation of costs across hospitals, Chen et al aimed to evaluate how costs for heart failure (HF) patients who did not receive procedures compared with those who did. The researchers used 2009-2010 data on adult HF hospitalizations in 281 hospitals that performed invasive procedures and had at least 25 HF hospitalizations. In the cohort, there was a total of 175,869 HF hospitalizations.
The hospitals were divided into two groups: those with lower procedural rates of 0 to 10 percent (141 hospitals) and those with higher procedural rates of more than 10 percent (140 hospitals). Low-procedure hospitals saw 65,955 HF hospitalizations, of which 62,262 did not involve invasive cardiovascular procedures. High-procedure hospitals had 109,914 HF hospitalizations; 93,636 did not involve any invasive cardiovascular procedures.
While 61 percent of low-procedure hospitals had 500 HF hospitalizations or less, 22 percent of high-procedure hospitals had the same volume. High-procedure hospitals had more hospitals that reported greater than 900 HF hospitalizations, 41 vs. 12 percent in low-procedure hospitals.
Those that performed a greater number of procedures were more likely to serve a more urban population. These hospitals were also more likely to be academic medical centers compared with those hospitals that performed a lower number of procedures, 45 vs. 18 percent.
Outcomes showed a significant cost differentiation between the two hospital subsets. These costs were $5,259 vs. $6,965 per hospitalization at low-procedure hospitals and high-procedure hospitals, respectively. When intravenous vasodilators, vasopressors, inotropes, etc., were used, these costs were reported to be $5,309 vs. $6,907.
The researchers reported that room and board, pharmacy costs and diagnostic imaging, among others factors, contributed to these costs.
“Although the spending patterns were similar between groups, overall spending was greater at the high-procedure hospitals across the majority of service areas,” the authors wrote. For example, pharmacy costs per patient were $1,297 at high-procedure hospitals and $991 at hospitals performing fewer procedures. The costs of supplies were $1,064 vs. $386, respectively.
“We suspect that differences in intensity and overall costs between groups may be related to differences in the structure and delivery of care and to the culture at high-procedure hospitals,” the researchers wrote.
Because previous research on hospital spending and patient outcomes has been mixed, the researchers said that their results should be interpreted with caution. The findings point to opportunities for hospitals that perform more procedures to reduce medication use, medical testing and other activities without hindering care.