BOCA RATON, FLA. – Hospitals that embrace the National Surgical Quality Improvement Program can expect to face significant expenses initially, but within a couple of years, the program becomes highly cost effective.
That’s been the experience at Pennsylvania State University’s Milton S. Hershey Medical Center, in Hershey, Pa., where the general and vascular surgery postoperative complication rate has dropped steadily as a consequence of NSQIP participation.
Indeed, by the time NSQIP had been in place for 2 years, the cost of avoiding one postop adverse event through NSQIP participation was roughly $9,000 less than the average cost of actually dealing with such a complication, Dr. Peter W. Dillon said at the annual meeting of the American Surgical Association.
"What it means for our institution is that at the end of year 2, treating the complication cost a lot more than paying NSQIP to avoid the complication. By the time we got to year 2, the program had a potential cost savings to the institution," explained Dr. Dillon, professor and chairman of the department of surgery at Hershey Medical Center.
Dr. Peter Dillon
There’s an important lesson here for surgeons and hospital officials elsewhere around the country. Today, only about 5% of U.S. acute care hospitals are on board with NSQIP. A major barrier to implementation is the program’s hefty direct costs. Those costs averaged more than $138,800 annually during the first 2 years of Hershey Medical Center’s participation, including licensing fees, administrative costs, travel for training, and information technology expertise. But after implementation, reduced surgical/medical errors result in substantial cost savings.
At Hershey, the postop adverse event rate fell from 17.1% at baseline to 13.8% after 1 year and to 12.7% after 2 years.
NSQIP was a challenge at the start. During the first 6 months of NSQIP involvement, the hospital was paying $25,471 per complication avoided. That’s a prohibitive cost, especially considering that it was substantially more than the $16,371 average cost of managing a real postop event.
By 2 years, however, the cost of avoiding one postop adverse event had fallen to $7,319, or $9,072 less than the cost attributed to an actual adverse event.
Discussant Dr. Sean J. Mulvihill commented that the Hershey study is important because the nation faces unsustainable escalation in the cost of medical care, and it’s incumbent on surgeons to find ways to increase the value of their services. Along those lines, compelling evidence exists to show that NSQIP reduces surgical morbidity and improves outcomes.
Dr. Mulvihill said he believes the Hershey group’s calculations are too conservative. The actual savings accrued through NSQIP involvement may be substantially greater.
For example, NSQIP can replace previous less-effective surgical quality improvement efforts. That saves institutional costs. Plus, as hospital administrators and department heads know all too well, the time will soon be at hand when hospitals will be punished financially for certain postop complications that are deemed by payers to be preventable. Hospitals will simply no longer receive payment for such events. Thus, preventing those complications from happening will yield additional financial value, explained Dr. Mulvihill, professor and chair of the department of surgery at the University of Utah, Salt Lake City.
"I predict the Hershey group will find additional added value with further passage of time. Our hospitals at University of Utah have been participating in NSQIP since 2001. It took us several years of maturation of the program before we hit our stride with serious quality improvement efforts coming directly from the program," the surgeon said.
The NSQIP program is a project of the American College of Surgeons. Dr. Dillon declared having no financial conflicts of interest.