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Vascular Surgeon- Hospitalist Co-management Improves In-hospital Mortality at the Expense of Increased In-hospital Cost
Rami Tadros, MD1, Peter L. Faries, MD1, Michael Stoner, MD2, Melissa Tardiff, BS1, Chien Yi Png, BS1, David Kaplan, Victoria Teodorescu, MD1, Windsor Ting, MD1, Ageliki G. Vouyouka, MD1, Michael L. Marin, MD1.
1The Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVE:
We have shown that vascular surgeon- hospitalist co-management resulted in improved in-hospital mortality rates. We now aim to assess the impact of the hospitalist co-management service (HCS) on healthcare cost.
METHODS:
A total of 1558 patients were divided into three cohorts and were compared: 516 in 2012, 525 in 2013, and 517 in 2014. The HCS began in January, 2013. Data were standardized for 6 vascular surgeons that were present 2012-2014. New attendings were excluded. Ten hospitalists participated. Case mix index (CMI), contribution margin (CM), total hospital charges (THC), length of stay (LOS), actual direct costs (ADC), and actual variable indirect cost (AVIC) were compared. Normalized comparisons were made. ANOVA with post-hoc tests as well as T-tests were performed.
RESULTS:
THC rose by a mean difference of , 578.31 between 2012 and 2014, p<0.0001, with a significant difference found between all groups during the study period, p=0.0004. ADC increased more than AVIC; however, both significantly increased over time, p=0.0002 and p=0.01, respectively. A mean ,326.63 increase in ADC was observed from 2012 to 2014, p<0.0001. AVIC only increased by an average .86 during the study period, p=0.01. Normalized comparisons of these metrics remained statistically significant. This increased cost was observed in the context of a higher CMI and longer LOS. CMI increased over the 3-years, p=0.006, increasing from 2.25 in 2012 to 2.53 in 2014, p=0.003. LOS increased by a mean 1.1 days (95% CI: 0.09-2.11, p=0.029) between 2012 and 2014, and significantly during the study period overall, p=0.038. During this time, re-admission rates decreased by ~2%, though this did not achieve significance, p=NS. Physician CM remained unchanged over the 3-year period, p=0.76. The most prevalent diagnosis related group (DRG) was consistent across all years. Variation in the principal diagnosis code was observed with the prevalence of circulatory disorders due to type II diabetes replacing atherosclerosis with gangrene as the most prevalent diagnosis in 2013 and 2014 compared to 2012.
CONCLUSION:
In-hospital cost is significantly higher since the start of the HCS. This surge may relate to increased CMI, LOS, and improved coding. This increase in cost may be justified as we have observed sustained reduction in in-hospital mortality and slightly improved re-admission rates.
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