The Cost to the Healthcare Facility
Thompson Reuters reports that as of the beginning of 2009, half of US hospitals were operating in the red, with the median profit margin less than zero percent.1 Andrew Hayek, President and CEO of Surgical Care Affiliates, predicts that case volumes for ASCs will likely remain negative, and John Vick, President of ASCs Inc , says that independent centers have seen a decline in profits. 32
Although the acquisition costs of opioids are low, the frequency of opioid-related ADEs following surgery creates a significant economic burden on healthcare providers.
Excessive pain, PONV, hypothermia, DVT, somnolence, respiratory depression, ileus and poor functional outcomes can all lead to decreased profitability. Here’s how the costs add up:
Operating Room
Each minute of OR time can cost a facility $15-20.33 Time spent in the OR for GA induction, emergence and troubleshooting means lost revenue because additional surgeries can’t be scheduled.
PACU
Reducing PACU times, as well as the cost to treat adverse events such as pain and PONV, can significantly reduce the cost per patient. Williams found that the average cost associated with a PACU admission following ACL surgery was $420.4 Factor in nurse intervention time and drug costs, and it can quickly add up. Carroll et al31 detailed the costs of treating PONV in terms of drug, labor, and delays in discharge delays. These authors were able to show $415 in lost revenue for each patient with PONV.
Length of Stay
A Frost and Sullivan survey of hospital professionals indicates that hospitals incur a cost of approximately $1,675 per day for a surgical inpatient.1 In a retrospective study examining the financial impact of opioid-related ADEs, Oderda and colleagues found median total hospital costs increased 7.4% and median LOS increased 10.3%.19
Unplanned Admission/Readmission
The cost of a readmission to the ED after a same day surgery can be as much as $1,000, with the cost rising to $13,902 for an inpatient admission.34 Uncontrolled pain was cited as the most common reason (38%) for readmission. Patients who experience pain and PONV following discharge are more likely to return as unplanned admissions. One study showed as many as 8% of patients receiving GAVA for ambulatory shoulder arthroscopy required unplanned hospital admission.25
Patient Satisfaction Drives Profitability
Hospitals with HCAHPS scores in the top 10% of the country are entitled to an extra 2% bonus of their Medicare payments for a year. The second 10% of the population are entitled to 1% of their Medicare payments.