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Invited Commentary
September 2016

Complications, Costs, and Financial Incentives for Quality

Author Affiliations
  • 1Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2016;151(9):830. doi:10.1001/jamasurg.2016.0811

As we move away from a fee-for-service model of health care reimbursement toward value-based purchasing, payers are assuming these new models will drive down costs while simultaneously improving quality by shifting the financial burden of complications to providers. The complexities of our health care reimbursement systems and cost-accounting make determining whether this is true incredibly difficult. On the heels of a widely publicized article1 showing that in our current financial environment, complications may actually represent increased profits for hospitals, Healy and colleagues2 argue that financial incentives are already correctly aligned to decrease postoperative complications. They find that complications led to a decreased profit margin for hospitals from an average 5.8% in patients without complications to 0.1% for patients with complications. Furthermore, they found complications led to increased costs for third-party payers represented in increased reimbursements paid from $16 434 for patients without complications to $36 060 for patients with complications. They argue that this demonstrates our current financial models are already aligned to incentivize quality.

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