The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system

Kaier, Klaus; Wolkewitz, Martin; Hehn, Philip; Mutters, Nico T.; Heister, Thomas

doi:10.1007/s10754-019-09267-w

Cited by 10 publications

(3 citation statements)

References 30 publications

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“…In an analysis of resource use and reimbursements from 188 731 patient visits to the University Medical Center Freiburg, Germany, it was found that each HAI led to a loss of approximately €4000 to the hospital. 3 Similar findings were presented in 2012 by Haenle et al, 4 who reported that a uneventful total knee arthroplasty (TKA) resulted in a €927 profit for the hospital. An infected TKA led to a loss for the hospital of €6356.…”

Section: Introductionsupporting

confidence: 72%

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany

Saunders,

Torrejon Torres,

Reuter

et al. 2023

Journal of Health Economics and Outcomes Research

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Background According to the European Centre for Disease Prevention and Control, surgical site infections (SSIs) constitute over 50% of all hospital-acquired infections. Reducing SSIs can enhance healthcare efficiency. Objective This study explores the cost consequences of implementing an SSI prevention bundle (SPB) in total hip and knee arthroplasty (THKA). Methods A health-economic model followed a cohort of THKA patients from admission to 90 days postdischarge. The perioperative process was modeled using a decision tree, and postoperative recovery and potential SSI evaluated using a Markov model. The model reflects the hospital payers’ perspective in Germany. The SPB includes antimicrobial incision drapes, patient warming, and negative pressure wound therapy in high-risk patients. SSI reduction associated with these interventions was sourced from published meta-analyses. An effectiveness factor of 70% was introduced to account for potential overlap of effectiveness when interventions are used in combination. Sensitivity analyses were performed to assess the robustness of model outcomes. Results The cost with the SPB was €4274.32 per patient, €98.27, or 2.25%, lower than that of the standard of care (€4372.59). Sensitivity analyses confirmed these findings, indicating a median saving of 2.22% (95% credible interval: 1.00%-3.79%]). The SPB also reduced inpatient SSI incidence from 2.96% to 0.91%. The break-even point for the SPB was found when the standard of care had an SSI incidence of 0.938%. Major cost drivers were the cost of inpatient SSI care, general ward, and operating room, and the increased risk of an SSI associated with unintended, intraoperative hypothermia. Varying the effectiveness factor from 10% to 130% did not substantially impact model outcomes. Conclusions Introducing the SPB is expected to reduce care costs if the inpatient SSI rate (superficial and deep combined) in THKA procedures exceeds 1%. Research into how bundles of measures perform together is required to further inform the results of this computational analysis.

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Section: Introductionsupporting

confidence: 72%

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany

Saunders,

Torrejon Torres,

Reuter

et al. 2023

Journal of Health Economics and Outcomes Research

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“…It is well known that HAIs have an impact on the need for prolonged hospitalization, higher readmission rates and increased mortality from both a short-and also long-term perspective 10,11 . Moreover, HAIs pose a considerable economic impact on healthcare systems, and their prevention is cost-effective 12 . Leung et al could demonstrate that patients with a longer preoperative length of stay are more prone to mediastinitis after cardiac surgery 6 .…”

Section: Discussionmentioning

confidence: 99%

An Extended Duration of the Pre-Operative Hospitalization is Associated with an Increased Risk of Healthcare-Associated Infections after Cardiac Surgery

Sulzgruber

Schnaubelt

Koller

et al. 2020

Sci Rep

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Nosocomial infections are a common complication in clinical practice with major impact on surgical success and patient outcome. The probability of nosocomial infections is rapidly increasing during hospitalization. Therefore, we investigated the impact of a prolonged pre-operative hospital stay on the development of post-operative infection. Within this prospective observational study, 200 patients scheduled for elective cardiac surgery were enrolled. Patients were followed during hospital admission and screened for the development of nosocomial infection. Logistic regression analysis was used to assess the impact of a prolonged pre-operative hospital stay on the development of infection. A total of 195 patients were suitable for the final analysis. We found a strong and direct association of the duration of pre-operative hospital stay and the number of patients developing infection (+23.5%; p = 0.006). Additionally, the length of patients' pre-operative hospital stay was independently associated with the development of post-operative nosocomial infection, with an adjusted OR per day of 1.38 (95%CI: 1.02-1.86; p = 0.036). A prolonged pre-operative hospital stay was significantly associated with the development of nosocomial infection after cardiac surgery. Those findings need to be considered in future clinical patient management in order to prevent unnecessary antibiotic use and potential harm to patients.

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“…The median cost for liver transplantation was not statistically significant with the corresponding hospital refund, the average DRG-based cost of liver transplantation was significantly higher than the actual cost, and the hospital's reimbursement for liver transplantation did not differ significantly from the actual registered cost [27]. From the hospital administration's perspective, it is not the additional costs of healthcare, but rather the cost-reimbursement relationship which guides decisions [28].…”

Section: Managing Drg-based Costsmentioning

confidence: 89%

A Multi-Level System of Performance Evaluation Using Diagnosis-Related Groups for Cost Containment

Shen¹,

Rouse²,

Zhang³

et al. 2021

Preprint

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This study aims to develop a performance evaluation system that can facilitate performance evaluation at region, hospital, and department levels to enable better cost management for sustainable development. A multi-level system of performance evaluation informs a hierarchical assessment of cost management from regions to hospitals to departments using diagnosis-related group (DRGs). Various metrics are developed employing the variances between targets and actuals where targets are determined from two perspectives: benchmarking using external regional prices and change management using internal data. Targets for the latter are statistically based and specifically incorporate variability. The model is applied to two hospitals, twenty departments, nine DRGs and 1071 inpatients. The analyses indicate that the approach can provide a practical evaluation tool that allows for particular characteristics at multiple levels. The system provides macro-micro and external-internal perspectives in performance, enabling high-level variances to be decomposed thereby identifying sources of performance variability and financial impact.

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The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system

Cited by 10 publications

References 30 publications

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany

An Extended Duration of the Pre-Operative Hospitalization is Associated with an Increased Risk of Healthcare-Associated Infections after Cardiac Surgery

A Multi-Level System of Performance Evaluation Using Diagnosis-Related Groups for Cost Containment

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