Massachusetts Chapter of the American College of Surgeons

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The Impact of Hospital Quality on Financial Performance Among Private Cardiac Surgery Hospitals
Samuel Enumah1, David C. Chang2
1Brigham and Women's Hospital, Boston, MA 2Massachusetts General Hospital, Boston, MA

Background: Quality reporting has remained a cornerstone within cardiac surgery for decades. However, the impact of hospital quality of care on hospital financial performance is less well known for hospitals performing cardiac surgery.
Methods: We performed an observational study of private U.S. hospitals performing cardiac surgery. We extracted quality metrics from Hospital Compare for years 2014 to 2018 and hospital characteristics from the American Hospital Association Annual Survey. We performed a mixed effects linear regression with fixed year effects with random hospital intercept effects. The dependent variable was total profit margin. Independent variables included the previous year’s thirty-day coronary artery bypass graft (CABG) mortality rate, thirty-day CABG readmission rate, Patient Safety Indicator-90 (PSI-90) score (higher scores indicate lower quality), and hospital characteristics.
Results: Our sample included 2,705 hospital-years from 827 unique hospitals. The median 30-day mortality rate was 3.1% (IQR 2.6 – 3.7) and median 30-day readmission rate was 13.9% (12.9 – 14.8). On mixed effects regression analysis, CABG-specific mortality and readmission rates were not independently associated with total profit margin. However, there was a significant association between high hospital overall PSI-90 score and decrease in total profit margin (adjusted difference comparing highest quartile to lowest quartile, -0.99% [95% CI, -1.64% to -0.33%], Figure).
Conclusion: Overall hospital quality may offer more insight into a cardiac hospital’s future financial performance than either cardiac-specific mortality or readmission rates.


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