Did Postoperative Mortality Increase After the Implementation of the Medicare Balanced Budget Act

BACKGROUND: The Balanced Budget Act (BBA) of 1997 was a cost-saving measure designed to reduce Medicare reimbursements by $116.4 billion from 1998 to 2002. Resulting financial strain could adversely affect the quality of patient care in hospitals. OBJECTIVE: We sought to determine whether 30-day mortality rates for surgical patients who developed complications changed at different rates in hospitals under different levels of financial strain from the BBA. METHODS: Pennsylvania hospital discharge data, financial data, and death certificate data from 1997 to 2001 were obtained. A retrospective multivariate analysis examined whether 30-day mortality rates from 8 postoperative complications varied based on degree of hospital financial strain. RESULTS: The average magnitude of Medicare payment reduction on overall hospital net revenues was estimated at 1.8% for hospitals with low BBA impact and 3.5% for hospitals with high impact in 1998, worsening to 2.0% and 4.8%, respectively, by 2001. Mortality rates changed at similar rates for high- and low-impact hospitals from 1997 to 1999, but from 1997 to 2000 mortality rates increased more among patients in high-impact compared with low-impact hospitals (P<0.05). From 2000 to 2001, mortality rates among impact groups converged. There were no statistically significant differences based on BBA impact in changes in nursing staff or length of stay. CONCLUSIONS: The mortality of surgical patients who developed postoperative complications increased to a greater degree in the short term in hospitals affected more by BBA. Measuring the quality impact of reimbursement cuts is necessary to understand cost-quality tradeoffs that may accompany cost-saving reforms

Health care · Mortality rate · Reimbursement · Retrospective cohort study · Economic and Financial Impacts of Cancer · Emergency Medicine · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Internal Medicine · Medicine

• Reductions in Medicare Payments and Patient Outcomes

  Yu-Chu Shen, Yu‐Chu Shen et al.•Medical Care•2013

  Añadir item

• Hospital Characteristics and Use of Innovative Surgical Therapies Among Patients With Kidney Cancer

  David C Miller, Stephanie Daignault et al.•Medical Care•2008

  Añadir item

• Comparison of Long-run Trends in 30-day Readmission by Degrees of Medicare Payment Cuts

  Yu-Chu Shen, Yu‐Chu Shen et al.•Medical Care•2016

  Añadir item

• Educational Levels of Hospital Nurses and Surgical Patient Mortality

  Linda H Aiken•JAMA•2003

  Añadir item

• Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

  Linda H Aiken•JAMA•2002

  Añadir item

• Nurse-Staffing Levels and the Quality of Care in Hospitals

  Jacob Needleman, Jack Needleman et al.•New England Journal of Medicine•2002

  Añadir item

• A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity

  Halbert White•Econometrica•1980

  Añadir item

• The Relationship of Hospital Characteristics and the Results of Peer Review in Six Large States

  Evelyn M Kuhn, Arthur J Hartz et al.•Medical Care•1991

  Añadir item

• The Balanced Budget Act of 1997 and U.S. Hospital Operations

  Open Access•Gloria J Bazzoli, Richard C Lindrooth et al.•INQUIRY The Journal of Health…•2004

  Añadir item

• Comorbidity Measures for Use with Administrative Data

  Anne Elixhauser, Claudia Steiner et al.•Medical Care•1998

  Añadir item

• Predicting In-Hospital Mortality

  Lisa I Iezzoni, Arlene S Ash et al.•Medical Care•1992

  Añadir item

• Hospital and Patient Characteristics Associated With Death After Surgery

  Jeffrey H Silber, Sharon Vegh Williams et al.•Medical Care•1992

  Añadir item

• Postoperative Adverse Events of Common Surgical Procedures in the Medicare Population

  Amy K Rosen, Jane M Geraci et al.•Medical Care•1992

  Añadir item

• A Spurious Correlation Between Hospital Mortality and Complication Rates

  Jeffrey H Silber, Paul R Rosenbaum•Medical Care•1997

  Añadir item