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Comment & Response |

Economic Impact of Surgical Complications on Hospitals ONLINE FIRST

Swathikan Chidambaram, BSc(Hons)1; En Lin Goh, BSc(Hons)1; Simon Erridge, BSc(Hons)1
[+] Author Affiliations
1School of Medicine, Imperial College London, London, England
JAMA Surg. Published online August 31, 2016. doi:10.1001/jamasurg.2016.2307
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To the Editor We would like to thank Healy et al1 for their study analyzing the economic impact of surgical complications on hospitals owing to recent policy changes. They conclude that hospitals will incur a financial burden because of a decrease in the overall profit margin from 5.8% for patients without complications to 0.1% for patients with complications.

However, the impact of this financial burden may be overstated because the proportion of patients with complications make up only 14.5% of the patient population, and the majority of patients had no complications. Hence, the 5.8% profit margin will be significantly higher in real terms than the 0.1% for patients without complications, implying that while profit margins will be slightly reduced, there is no actual financial burden on hospitals. Because the relative difference of −5.7% applies to only 1.5% of the population, the overall profit margin is still a respectable 5.0%. In the case of surgical complications, bundled payments effectively pave a middle ground between fee-for-service and capitation reimbursements without compromising the quality of health care or excessively straining either third parties or hospitals. Their study1 shows an overall negative profit margin over a 7-year period. A more convincing approach would be an appraisal of the finances over narrower time frames showing a consistent loss over these periods. Doing so will eliminate many confounding external factors such as the ever-changing economic climate that could impact the results.

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August 31, 2016
Barry Rosenberg, MD, MBA; Bennett Lane, MS; Atul Gawande, MD, MPH
1The Boston Consulting Group, Chicago, Illinois
2Harvard Medical School, Boston, Massachusetts
3Ariadne Labs, Brigham and Women’s Hospital and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA Surg. Published online August 31, 2016.;():. doi:10.1001/jamasurg.2016.2308.
August 31, 2016
Mark A. Healy, MD, MS; Justin B. Dimick, MD, MPH
1Department of Surgery, University of Michigan, Ann Arbor2Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor3Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor
1Department of Surgery, University of Michigan, Ann Arbor2Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor3Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor4Surgical Innovation Editor, JAMA Surgery
JAMA Surg. Published online August 31, 2016.;():. doi:10.1001/jamasurg.2016.2309.
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