Quality of Care and Cost at Safety-Net Hospitals—Is Redistribution of Cases Possible?

In this issue of JAMA Surgery, Go et al¹ use University HealthSystem Consortium data to demonstrate that high-burden hospitals (HBHs), while providing a safety net and caring for the most severely ill patients, had worse outcomes and higher costs after pancreaticoduodenectomy compared with low-burden hospitals (LBHs) and medium-burden hospitals (MBHs). Sensitivity analyses were performed to simulate after pancreaticoduodenectomy (1) the effect of improved hospital performance and (2) the influence of redistribution of care on cost. In the model, a 50% reduction in drug-related group (DRG) codes for major and minor complications or comorbidities resulted in a $4607 decrease in cost per patient. Redistribution of patients to LBHs and MBHs resulted in a cost savings of $9155 per patient.