Safety-Net Hospitals Can Reduce Costs By Shifting Complex Surgery Patients to Other Hospitals Interview with:

Richard Hoehn, MD Resident in General Surgery College of Medicine University of Cincinnati

Dr. Richard Hoehn

Richard Hoehn, MD
Resident in General Surgery
College of Medicine
University of Cincinnati What is the background for this study? What are the main findings?

Response: A recent study from our research group (Hoehn et al, JAMA Surgery, 2015) found that safety-net hospitals perform complex surgery with higher costs compared to other hospitals, and that these higher costs are potentially due to intrinsic differences in hospital performance.

In this analysis, we decided to simulate different policy initiatives that attempt to reduce costs at safety-net hospitals. Using a decision analytic model, we analyzed pancreaticoduodenectomy performed at academic hospitals in the US and tried to reduce costs at safety-net hospitals by either
1) reducing their mortality,
2) reducing their patients’ comorbidities and complications, or
3) sending their patients to non-safety-net hospitals for their surgery.

While reducing mortality had a negligible impact on cost and reducing comorbidities/complications had a noticeable impact on cost, far and away the most successful way to reduce costs at safety-net hospitals, based on our model, was to send patients away from safety-net hospitals for their pancreaticoduodenectomy. What should readers take away from your report?

Response: For complex pancreatic surgery at safety-net hospitals, our model suggests that improving outcomes or perioperative patient management has a limited impact on cost-reduction. Looking strictly at the numbers, it appears that redistributing patients away from safety-net hospitals has the greatest impact on cost reductions for pancreaticoduodenectomy.

However, redistributing patients away from safety-net hospitals is not necessarily a realistic solution. It is known that patients at these hospitals travel shorter distances for care, likely due to socioeconomic reasons. If we shut down certain services at these hospitals we may inadvertently cut off access to care for these patients. Therefore, it is necessary to better understand the differences in care that lead to these increased costs. What recommendations do you have for future research as a result of this study?

Response: More granular analyses are necessary to understand the disparities in care that occur at safety-net hospitals. There is no shortage of data suggesting that short-term “outcomes” are worse at these centers. There are also studies indicating that hospital resources correlate with outcomes. However, no available research has identified specific mechanisms by which safety-net hospitals can improve their outcomes or cost-effectiveness. Is there anything else you would like to add?

Response: Safety-net hospitals are a valuable institution in the United States. They care for a vulnerable patient population that other hospitals ignore. Although we show that redistributing patients away from safety-net hospitals can reduce costs, shutting down these hospitals or services they provide is unrealistic. Therefore, we need to better understand the challenges they face in order to improve their outcomes. Thank you for your contribution to the community.


Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on July 28, 2016 by Marie Benz MD FAAD