一家三级医院门诊结肠切除术的成本分析:医学经济评估预测。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Health Services Insights Pub Date : 2024-09-24 eCollection Date: 2024-01-01 DOI:10.1177/11786329241284400
Fabio Agri, William Möller, Philip Deslarzes, Charles André Vogel, Dieter Hahnloser, Martin Hubner, Nicolas Demartines, Fabian Grass
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引用次数: 0

摘要

研究目的缩短住院时间是减轻医疗系统长期压力的激励措施。本研究旨在利用诊断相关组(DRG)编码,分析日间入院(DAS)和门诊策略对前瞻性支付系统(PPS)中结肠切除术的财务影响:方法:纳入2019年1月1日至2020年12月31日期间接受左右结肠切除术的连续患者。根据预定义标准对虚拟门诊和日间入院手术组与在实际传统住院环境中接受手术的同组患者进行医疗经济评估比较。第二步,对虚拟门诊组的术后并发症进行评估。成本收入分析采用微观成本计算法,包括直接医疗成本:总体而言(N = 257),97 例(37.7%)结肠切除术可能符合门诊策略。实际住院策略的总成本为 3 634 392 美元,总收入为 3 571 069 美元,成本覆盖率为 98%。虚拟 DAS 策略的结果是净损失 15 800 美元(覆盖率为 99%),原因是 4 个住院时间较短的异常值导致报销额度减少,无法实现 16 208 美元的正净结果。试点参考门诊病例的收入和成本分别为 7479 美元和 6911 美元(成本覆盖率为 108%):结论:从任何一家医院和医疗系统的角度来看,为选定患者实施门诊结肠切除术都是最节约成本的选择。然而,在为避免不良激励而实施的前瞻性支付系统中,不良激励会无意中使表现最好的医院处于不利地位,并阻碍高价值策略的广泛采用。
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Cost Analysis of Outpatient Colectomy in a Tertiary Center: A Projected Medico-Economic Evaluation.

Aim of the study: Short stay processes are incentives to unburden chronically stressed healthcare systems. The aim of this study is to analyze financial implications of day admission (DAS) and outpatient strategies for colon resections in a prospective payment system (PPS) using Diagnosis Related Group (DRG) coding.

Methods: Consecutive patients undergoing left and right colonic resections between January 1, 2019 and December 31, 2020 were included. Medico-economic evaluations of the virtual outpatient and day admission surgery groups based on predefined criteria were compared to the identical group of patients who underwent surgery in the actual traditional inpatient setting. In a second step, postoperative complications of the virtual outpatient group were assessed. Cost-revenue analysis was performed using a micro-costing approach including direct medical costs.

Results: Overall (N = 257), 97 (37.7%) colectomies would have been potentially eligible for an outpatient strategy. The global costs of the actual inpatient strategy totaled USD 3 634 392 with a global revenue of USD 3 571 069, corresponding to a cost coverage rate of 98%. The result of the virtual DAS strategy would have been a net loss of USD 15 800 (coverage rate of 99%) due to 4 low length of stay outliers triggering a reimbursement reduction and preventing a positive net result of USD 16 208. The pilot reference outpatient case's revenue and cost amounted to respectively USD 7479 and USD 6911 (cost coverage of 108%).

Conclusion: From both any given hospital and healthcare system point of view, elective outpatient colectomy for selected patients is the most cost-saving option. However, in a prospective payment system implemented to avoid bad incentives, the latter can unintentionally disadvantage best performing hospitals and impede widespread adoption of high-value strategies.

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来源期刊
Health Services Insights
Health Services Insights HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.60
自引率
0.00%
发文量
47
审稿时长
8 weeks
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