April 17—The occurrence of postsurgical complications was associated with a higher per-encounter hospital contribution margin for patients covered by Medicare and private insurance but a lower one for patients covered by Medicaid and who self-paid, according to a study in the April 17 issue of JAMA

The study retrospectively analyzed data for all inpatient surgical discharges during 2010 from a not-for-profit 12-hospital system in the southern United States. Of 34,256 surgical discharges, 1,820 patients (5.3 percent) experienced one or more postsurgical complications.

The researchers found that the occurrence of one or more complications was associated with higher hospital costs in all payer types. Patients experiencing one or more complications were associated with a higher contribution margin of $39,017 per patient with private insurance ($55,953 vs. $16,936) and $1,749 per Medicare patient ($3,629 vs. $1,880) compared with that of patients without complications. In the case of patients with private insurance experiencing one or more complications, hospitals earned a 330 percent higher profit margin.

In contrast, for Medicaid and self-pay procedures, those with complications were associated with significantly lower contribution margins than those without complications, according to the study.

Publication Date: Wednesday, April 17, 2013