微博观点：治疗术后并发症能给医院带来更大收益，打击医院减少术后并发症的积极性

星火

#我眼中的美国医疗# 美国现有医疗体制的弊端：JAMA 今年4月文：手术后出现并发症不是件好事，但事实上，治疗术后并发症能给医院带来更大的收益，从而打击医院减少术后并发症的积极性。出现术后并发症，私立医保公司平均向医院多付3.9万美元/人，国家医保公司平均多付1700美元。http://t.cn/zQakCMY
Relationship Between Occurrence of Surgical Complications and Hospital Finances Sunil Eappen, MD; Bennett H. Lane, MS; Barry Rosenberg, MD, MBA; Stuart A. Lipsitz, ScD; David Sadoff, BA; Dave Matheson, JD, MBA; William R. Berry, MD, MPA, MPH; Mark Lester, MD, MBA; Atul A. Gawande, MD, MPH
JAMA. 2013;309(15):1599-1606. doi:10.1001/jama.2013.2773.






ABSTRACT



Importance  The effect of surgical complications on hospital finances is unclear.
Objective  To determine the relationship between major surgical complications and per-encounter hospital costs and revenues by payer type.
Design, Setting, and Participants  Retrospective analysis of administrative data for all inpatient surgical discharges during 2010 from a nonprofit 12-hospital system in the southern United States. Discharges were categorized by principal procedure and occurrence of 1 or more postsurgical complications, using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes. Nine common surgical procedures and 10 major complications across 4 payer types were analyzed. Hospital costs and revenue at discharge were obtained from hospital accounting systems and classified by payer type.
Main Outcomes and Measures  Hospital costs, revenues, and contribution margin (defined as revenue minus variable expenses) were compared for patients with and without surgical complications according to payer type.
Results  Of 34 256 surgical discharges, 1820 patients (5.3%; 95% CI, 4.4%-6.4%) experienced 1 or more postsurgical complications. Compared with absence of complications, complications were associated with a $39 017 (95% CI, $20 069-$50 394; P < .001) higher contribution margin per patient with private insurance ($55 953 vs $16 936) and a $1749 (95% CI, $976-$3287; P < .001) higher contribution margin per patient with Medicare ($3629 vs $1880). For this hospital system in which private insurers covered 40% of patients (13 544), Medicare covered 45% (15 406), Medicaid covered 4% (1336), and self-payment covered 6% (2202), occurrence of complications was associated with an $8084 (95% CI, $4903-$9740; P < .001) higher contribution margin per patient ($15 726 vs $7642) and with a $7435 lower per-patient total margin (95% CI, $5103-$10 507; P < .001) ($1013 vs &#8722;$6422).
Conclusions and Relevance  In this hospital system, the occurrence of postsurgical complications was associated with a higher per-encounter hospital contribution margin for patients covered by Medicare and private insurance but a lower one for patients covered by Medicaid and who self-paid. Depending on payer mix, many hospitals have the potential for adverse near-term financial consequences for decreasing postsurgical complications.



国内情况类似呵，患者花费与科室及个人收人紧密相关啊。

星火

天堂小鱼_：
当然亚历山大！！ 护士需要做很多chart audit 的工作，有没有每两小时翻身，有没有血栓的预防治疗，有没有防摔倒措施，入院病人有没有打流感疫苗（十月到三月），术前抗生素，心衰病人出院用药， too much work!
实际上美国联邦医保Medicare 对医院越来越苛刻。医院内的很多并发症Medicare 都以后不再报销了，比如院内感染，DVT，褥疮等等。所以院内的质量监控需要经常监控是否术前一小时给了抗生素，术后几天拔掉尿管等等。似乎这样对提高医疗水平有帮助，但给美国医院很大的压力。

星火

协和老万：

实际上，并发症出得过多的话，医院声誉会受损，不但患者不会来，保险公司也会避之则吉。对于个案来说，可能是得到了更多的赔付，对于整体来说，医院是得不偿失的。对于医生而言，没有人会以故意造成并发症来生财的。

黄河之水

还是顺其自然的好，相信“不是正常的事，不会长久”。

热带雨林2010

作为一名医生都会尽量减少患者的痛苦，我想没有任何一名医生希望他为病人做手术后出现并发症。

星火

健康界网站
【天津医院护士分五级 危重患者由高级护士负责】天津市推进责任制整体护理工作模式，各医院根据护士的工作能力、工作年限、学历等，将临床护理岗位划分为五个等级，只有最高级别的护士才有资格照料危重患者。同时，护士级别将与个人收入挂钩，实现多劳多得、优绩优酬。每日新报http://t.cn/zQSmPrL

星火

中国医学论坛报
【嚼口香糖助妇科腹腔镜术后患者肠蠕动】奥地利一项随机对照研究显示，作为微创手术后的辅助治疗，术后咀嚼口香糖似乎有利于肠动力恢复。研究者称，应推荐妇科腹腔镜术后患者咀嚼口香糖。该研究论文2013年7月发表于《妇产科学》［Obstet Gynecol 2013,122（1）：85］杂志。http://t.cn/zQSRm3X

604885504

论坛的老师提供的信息很前沿，学习了。

神通广大

“根据护士的工作能力、工作年限、学历等，将临床护理岗位划分为五个等级，只有最高级别的护士才有资格照料危重患者”。这样或许更能刺激护理工作者的积极性和创造性也更有利于护理学科的发展。

子夜阳光

原来就听说过美国的有些医院要为医院感染的费用买单

草原星空

星火 发表于 2013-8-4 10:15

                               
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协和老万：

实际上，并发症出得过多的话，医院声誉会受损，不但患者不会来，保险公司也会避之则吉。对于 ...

医生们也许对有些控制措施的执行力是不强，也许对有些控制措施持怀疑态度，但绝对不会故意给病人造成并发症的。

衣带渐宽

在保险公司开的医院里这样的情况应该会更少吧