Objectives: Severe financial pressures in recent years have resulted in a sustained increase in nationwide healthcare costs in nearly every measurable category, with the majority of health centers reporting slim to net negative margins. We sought to examine the evolving cost, reimbursement, and net revenue trends associated with commonly performed vascular surgical procedures at a tertiary medical center.
Methods: The five most frequently performed vascular surgeries at our institution between 2019 and 2022 were identified: arteriovenous fistula creation, arteriovenous graft placement, carotid endarterectomy, endovascular aortic repair, and lower extremity angiogram with percutaneous transluminal angioplasty and/or stent. Direct hospital costs, including implants, labor, and reimbursement per encounter were examined, as were overall reimbursement patterns and insurance payor mix. Data was standardized per individual case, and real-time accounting figures were utilized instead of more commonly reported estimates or projections.
Results: When values from the combined, five-case cohort in 2019 were compared to those in 2020, an average increase in direct cost of 31% (p <.001) per case was seen, with sustained increases in the ensuing two years, respectively (2021, +30%, p<.001; 2022, +32%, p<.001) compared to 2019. When reimbursement from 2019 was compared to 2020, an increase of 20% (p<.001) was seen, with sustained increases in the ensuing two years, respectively (2021, +21%, p<.001; 2022, +21%, p<.001) compared to 2019. The differential in increased direct cost/case versus a more modest increase in reimbursement/case yielded an average yearly decrease in net revenue of -11.5%. Insurance payor mix did not change over time, with Medicare comprising 71±1% of all payors.
Conclusions: Our results demonstrate an ongoing increase in direct costs associated with the most commonly performed vascular surgeries at a tertiary center between 2019 and 2020 that has been sustained in 2021 and 2022. The significantly lower, concomitant increase in reimbursement demonstrates an ominous trend of eroding hospital revenue in the current era of razor-thin operating margins. Unique access to real-time accounting figures instead of more commonly reported Medicare estimates or institutional projections increases the accuracy and generalizability of this data, as does the inclusion of open surgical, endovascular, inpatient and outpatient surgeries in the examined cohort. Clearly this precarious trend is untenable, and tangible fiscal recovery will require sustained, strategic financial allocation.
