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. 2024 Jan 18:17:11786329231222970.
doi: 10.1177/11786329231222970. eCollection 2024.

Day Admission Surgery Program in a Prospective Payment System: What Are the Financial Incentives?

Fabian Grass  1 , Matthias Roth-Kleiner  2 , Nicolas Demartines  1   3 , Fabio Agri  1   4
Affiliations

Day Admission Surgery Program in a Prospective Payment System: What Are the Financial Incentives?

Fabian Grass et al. Health Serv Insights. .

Abstract

Background: Day admission surgery (DAS) is meant to provide a better in-hospital experience for patients and to save costs by reducing the length of stay. However, in a prospective payment system, it may also reduce the reimbursement amount, leading to unintended incentives for hospitals.

Methods: Over a 4-month period in 2021 and based on predefined clinical and logistic criteria, patients from different surgical sub-specialties were identified to follow the institutional DAS program. Revenue-analysis was performed, considering the Swiss diagnosis-related group (SwissDRG) prospective payment policy. Revenue with DAS program was compared to revenue if patients were admitted the day prior surgery (No DAS) using nonparametric pooled bootstrap t-test. All other costs considered identical, an estimation of the average cost spared due to the avoidance of pre-operative hospitalization in the DAS setting was carried out using a micro-costing approach.

Results: Overall, 105 inpatients underwent DAS over the study period, totaling a revenue of CHF 1 209 840. Among them, 25 patients (24%) were low outliers due to the day spared from the DAS program and triggering a mean (SD) financial discount of Swiss Francs (CHF) 4192 (2835), yielding a total amount of CHF 105 435. DAS revealed a mean revenue of CHF 7320 (656), compared to CHF 11 510 (1108) if patients were admitted the day before surgery (No DAS, P = .007).

Conclusion: In a PPS, anticipation of financial penalties when implementing a DAS for all-comers is key to prevent an imbalance of the hospital equation if no financial criteria are used to select eligible patients. Promptly revising workflow to maintain constant fixed costs for a greater number of patients may be a valuable hedging strategy.

Keywords: Day admission surgery (DAS); costs; financial penalties; incentives; prospective payment system (PPS); revenue.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
DRG chart: Inlier and outlier reimbursement.
Figure 2.
Figure 2.
Revenue comparison according to admission strategy.
Figure 3.
Figure 3.
Example of extreme deduction due to a low LOS outlier.
Figure 4.
Figure 4.
Hedging strategy of day admission surgery (DAS).
See this image and copyright information in PMC

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References

    1. Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD. Case mix definition by diagnosis-related groups. Med Care. 1980;18:iii,1-iii,53. - PubMed
    1. Freeman JL, Fetter R, Nowbold R, Rodrigues J. Hospital utilisation before and after the implementation of DRGs for hospital payment: US, 1979–1984. J Manag Med. 1986;1:309-323.
    1. Mayes R. The origins, development, and passage of Medicare’s revolutionary prospective payment system. J Hist Med Allied Sci. 2007;62:21-55. - PubMed
    1. SwissDRG. Les forfaits par cas dans les hôpitaux suisses. Information de base pour les professionnels. Accessed December 22, 2022. https://www.swissdrg.org/application/files/4115/0234/7369/170810_SwissDR...
    1. Freeman JL, Fetter RB, Park H, et al.. Diagnosis-related group refinement with diagnosis- and procedure-specific comorbidities and complications. Med Care. 1995;33:806-827. - PubMed

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