Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis
Margem de contribuição por hora de sala cirúrgica para realocar o tempo não utilizado da sala cirúrgica: uma análise de custo-efetividade
Andrea Saporito, Davide La Regina, Andreas Perren, Luca Gabutti, Luciano Anselmi, Stefano Cafarotti, Francesco Mongelli
Abstract
Background and objectives
Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness.
Methods
For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH.
Results
Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random “first come–first serve” basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001).
Conclusion
Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.
Keywords
Resumo
Justificativa
A margem de contribuição por hora (MCH) foi proposta nos sistemas de saúde para aumentar a lucratividade das salas cirúrgicas. O objetivo do nosso estudo é propor um modelo simples e reprodutível para calcular o MCH e aumentar o custo-efetividade.
Métodos
Para os dez procedimentos cirúrgicos mais comumente realizados em nossa instituição, coletamos prospectivamente o reembolso do grupo relacionado ao diagnóstico (GRD), custos variáveis e tempo médio de procedimento. Quantificamos a parcela do tempo total da sala de cirurgia a ser realocada com um risco mínimo de superação. Além disso, calculamos o MCH total com uma realocação aleatória por ordem de chegada. Por fim, priorizando procedimentos com maior MCH, fizemos uma simulação calculando o MCH total.
Resultados
Durante um período de dois meses, identificamos 14,5 horas de sala cirúrgica não utilizada para realocar. No caso de uma base aleatória de “primeiro a chegar, primeiro a servir”, os ganhos totais foram de 87.117 dólares americanos (USD). Por outro lado, com uma realocação que priorizou procedimentos com alta CMH, foi possível ganhar 140.444 USD (p < 0,001).
Conclusão
A atividade cirúrgica pode ser uma das atividades mais lucrativas para os hospitais, mas uma gestão custo-efetiva requer a compreensão de seu perfil de custos. A realocação do tempo não utilizado da sala cirúrgica de acordo com o MCH pode representar uma ferramenta simples, reprodutível e confiável para casos eletivos em lista de espera. Em nossa experiência, ajudou a melhorar a relação custo-benefício do conjunto operacional.
Palavras-chave
References
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Submitted date:
08/09/2020
Accepted date:
03/28/2021
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