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Comment & Response |

Economic Impact of Surgical Complications on Hospitals ONLINE FIRST

Barry Rosenberg, MD, MBA1; Bennett Lane, MS2; Atul Gawande, MD, MPH3
[+] Author Affiliations
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
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To the Editor Healy and colleagues1 published a thoughtful analysis on the hospital and payer economics of surgical complications for 5120 patients treated at a university health system during the period from 2008 to 2015.

Their analysis demonstrates a decrease in total margin from 5.8% to 0.1% for patients with surgical complications. The figures and tables focus exclusively on total margin. Contribution margin was not detailed except to report that “contribution margin (reimbursement less variable costs only) was found to decrease with complications overall, from 58.8% without complications to 56.6% with complications.”1 We suspect that by focusing all of the figures and tables on total margin and reporting contribution margin only on a percentage basis, hospitals’ financial incentives were not fully elucidated for readers.

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August 31, 2016
Swathikan Chidambaram, BSc(Hons); En Lin Goh, BSc(Hons); Simon Erridge, BSc(Hons)
1School of Medicine, Imperial College London, London, England
JAMA Surg. Published online August 31, 2016.;():. doi:10.1001/jamasurg.2016.2307.
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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