Balancing revenue generation with capacity generation: case distribution, financial impact and hospital capacity changes from cancelling or resuming elective surgeries in the US during COVID-19

Autor:	Rupam Das, Jessica N. Cohan, Benjamin S. Brooke, Joshua J. Horns, Heidi A. Hanson, James M. Hotaling, Marta L. McCrum, Alexander Campbell, Brenna C. Kelly, Joseph E. Tonna
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	Overcapacity medicine.medical_specialty Hospital bed MEDLINE COVID-19 pandemic Article Health administration law.invention 03 medical and health sciences 0302 clinical medicine law Intensive care medicine Humans Revenue 030212 general & internal medicine Economics Hospital Elective surgery Resource allocation Pandemics health care economics and organizations Retrospective Studies Earnings business.industry Health Insurance Portability and Accountability Act Health Policy lcsh:Public aspects of medicine COVID-19 Total revenue lcsh:RA1-1270 medicine.disease Intensive care unit United States 3. Good health Intensive Care Units Available hospital beds Elective Surgical Procedures Hospital Bed Capacity Emergency medicine 030221 ophthalmology & optometry Medical emergency business Critical care capacity Research Article Cohort study
Zdroj:	BMC Health Services Research, Vol 20, Iss 1, Pp 1-7 (2020) BMC Health Services Research medRxiv article-version (status) pre article-version (number) 1
ISSN:	1472-6963
Popis:	BackgroundTo increase bed capacity and resources, hospitals have postponed elective surgeries, although the financial impact of this decision is unknown. We sought to report elective surgical case distribution, associated gross hospital earnings and regional hospital and intensive care unit (ICU) bed capacity as elective surgical cases are cancelled and then resumed under simulated trends of COVID-19 incidence.MethodsA retrospective, cohort analysis was performed using insurance claims from 161 million enrollees from the MarketScan database from January 1, 2008 to December 31, 2017. COVID-19 cases were calculated using a generalized Richards model. Centers for Disease Control (CDC) reports on the number of hospitalized and intensive care patients by age were used to estimate the number of cases seen in the ICU, the reduction in elective surgeries and the financial impact of this from historic claims data, using a denominator of all inpatient revenue and outpatient surgeries.ResultsAssuming 5% infection prevalence, cancelling all elective procedures decreases ICU overcapacity from 340% to 270%, but these elective surgical cases contribute 78% (IQR 74, 80) (1.1 trillion (T) US dollars) to inpatient hospital plus outpatient surgical gross earnings per year. Musculoskeletal, circulatory and digestive category elective surgical cases compose 33% ($447B) of total revenue.ConclusionsProcedures involving the musculoskeletal, cardiovascular and digestive system account for the largest loss of hospital gross earnings when elective surgery is postponed. As hospital bed capacity increases following the COVID-19 pandemic, restoring volume of these elective cases will help maintain revenue.DECLARATIONSEthics approval and consent to participateThis study did not meet criteria for IRB review.Consent for publicationNot applicableAvailability of data and materialsTo facilitate research reproducibility, replicability, accuracy and transparency, the associated analytic code is available on the Open Science Foundation [1] (OSF) repository, [DOI 10.17605/OSF.IO/U53M4] at [https://osf.io/u53m4]. The data that support the findings of this study were obtained under license from Truven. Data were received de-identified in accordance with Section 164.514 of the Health Insurance Portability and Accountability Act (HIPAA).Competing interestsJET received modest financial support for speakers fees from LivaNova and from Philips Healthcare, outside of the work. The other authors declare that they have no competing interests.FundingJET is supported by a career development award (K23HL141596) from the National Heart, Lung, And Blood Institute (NHLBI) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. None of the funding sources were involved in the design or conduct of the study, collection, management, analysis or interpretation of the data, or preparation, review or approval of the manuscript.Authors’ contributionsJET, JH had full access to all the data in the study, takes responsibility for the integrity of the data, the accuracy of the data analysis, and the integrity of the submission as a whole, from inception to published article. JET, HH, BSB, JC, MM, JJH, JH conceived study design; JET, HH, BSB, JC, MM, JJH, RD, BK, AJC, JH contributed to data acquisition and analysis; JET, HH, JJH, JH drafted the work; all authors revised the article for important intellectual content, had final approval of the work to be published, and agree to be accountable to for all aspects of the work.AcknowledgementsNot applicable
Databáze:	OpenAIRE
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