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Surgical mortality stats at CAHs on par with bigger hospitals

By Maureen McKinney
Posted: May 1, 2013 - 4:00 pm ET

While recent research showed small, rural hospitals registered worse mortality outcomes than their larger urban and suburban counterparts, they fare no worse than their larger counterparts on mortality following common, low-risk surgical procedures, such as appendectomy and knee replacement.

That's according to a newly released study in JAMA Surgery, which examined the quality and costs associated with surgical care delivered at critical-access hospitals.

Hospitals that have the critical-access designation are located primarily in rural areas, have no more than 25 beds and receive at-cost reimbursement for Medicare services.

Using data from the Nationwide Inpatient Sample and the American Hospital Association, researchers from the University of Michigan Health System, Ann Arbor, assessed hospitals' length of stay, total hospital costs and in-hospital mortality associated with eight common surgical procedures.

Adjusted mortality rates were virtually the same for critical-access and non-critical-access hospitals for all of the procedures except hip fracture repair, for which death rates were slightly higher at critical-access facilities.

And while average lengths of stay were lower at critical-access hospitals for some of the procedures, costs of surgical treatment were 9.9% to 30% higher, according to the study.

President Barack Obama's budget for 2014 includes a provision that would decrease payments for critical-access hospitals from 101% to 100% of costs. Such a move may seem like a reasonable money-saving strategy, the study's authors said, but they cautioned that reducing reimbursement for resource-strapped rural hospitals could hinder patients' access to care.

“Because we observed similar cost disparities for both elective and nonelective procedures, a potential middle ground might be for policymakers to limit proposed changes in payment levels to elective inpatient operations, where access-related implications for communities served by CAHs may be less acute,” the authors wrote in the study. “Even with this approach, however, it would be important to monitor the effects of such changes, particularly because elective procedures likely represent a pivotal revenue stream for both CAHs and rural surgeons working in these communities.”

The study comes just one month after researchers from the Harvard School of Public Health, Boston, publishing in the Journal of the American Medical Association, found that 30-day mortality rates for heart attack, heart failure and pneumonia have risen at critical-access hospitals over the past decade while dropping at non-critical-access facilities.

The authors of this latest article on surgical quality said the sharp differences in medical and surgical outcomes uncovered by the two studies “may be explained by the elective (and therefore potentially less acute) nature” of many surgical procedures.

Follow Maureen McKinney on Twitter: @MHMMcKinney

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