Negative trends have been strongly projected for the healthcare system during the pandemic—yet, while COVID has posed many new challenges, financial strain is not a new issue for hospitals. All organizations need positive operating margins to survive long-term; this is especially important in the healthcare sector to ensure continuous and quality patient care.¹ Despite this, the median pre-pandemic hospital operating margin was just 3.5%, with 32% of US hospitals dealing with negative margins in early 2019.¹ COVID exacerbated this problem, as hospitals were overwhelmed, understaffed, and facing severe PPE shortages. In early 2020, 49% of US hospitals reported negative operating margins.¹
COVID greatly limited hospital procedures as public health guidelines recommended postponing all non-essential surgeries. This has led to an immense surge of surgical demand now that restrictions are being eased across the country. The American Hospital Association warns it is essential that HCPs and healthcare organizations are prepared for this influx of patients.² As surgical site infection (SSI) is a significant risk during post-operative care, it is important to remain vigilant during this time. SSI is the most common type of hospital-acquired infection (HAI), with an estimated occurrence of 160,000 to 300,000 cases per year in the US. In fact, it accounts for more than 20% of all reported HAIs.³
SSI is a substantial financial burden for hospitals.³’⁴ While SSI costs vary based on the degree of infection and the surgical site, the estimated average cost can be greater than $25,000. This value increases to more than $90,000 if the SSI involves a prosthetic implant.⁵ Overall, SSI costs the US healthcare system an estimated $3.5 to $10 billion each year.³ These financial strains have been exacerbated since 2008, when the US Centers for Medicare and Medicaid Services (CMS) stopped reimbursing hospitals for HAIs like SSI.⁶
SSI prevention has since become a critical objective for institutions nationwide, aiming to improve patient quality of care and reduce associated costs. The good news is that up to 60% of SSIs are preventable if proper measures are taken during perioperative care. As a result, SSIs are now a primary target of institutional quality control measures and a key “Pay-for-Performance” metric.³
The National Healthcare Safety Network (NHSN), of the Center for Disease Control and Prevention (CDC), is the nation’s most widely used healthcare-associated infection tracking system and the largest HAI reporting system in the US. The NHSN’s Patient Safety Component Manual lists 3 types of SSIs⁷:
- Superficial incisional – Involves only skin and subcutaneous tissue of the incision
- Deep incisional – Involves deep soft tissues of the incision (eg, fascial and muscle layers)
- Organ/Space – involves any part of the body deeper than the fascial/muscle layers, that is opened or manipulated during the operative procedure
While SSIs have been shown to increase health care costs, few studies have conducted an analysis from the perspective of hospital administrators. Shepard et al completed a retrospective study to determine the change in hospital profit due to SSIs. The study was performed at 4 of The Johns Hopkins Health System acute care hospitals in Maryland.⁴
Over the 3-year study period, there were 399,627 inpatient admissions, 25,849 surgical procedures of interest, and 618 SSIs identified, resulting in an SSI rate of 2.76 per 100 surgical procedures. The data suggested that the net loss in profits due to SSIs for The Johns Hopkins Health System was between $4,147 and $22,239 per SSI, not accounting for the cost to backfill patients or the cost of the intervention to prevent the SSIs.⁴
The study concluded clinicians may persuade hospital executives to invest in costly SSI prevention measures through a cost-benefit analysis if proper financial terminology is leveraged. It is also imperative to use accurate financial figures to maintain the financial well-being of health care institutions and promote patient safety.4
Minimizing infection risk is essential not only to patient well-being, but to maintaining hospital financial stability as well. As many patients begin to undergo non-emergent surgeries again, focus on SSI prevention remains as important as ever. Eloquest Healthcare is committed to providing solutions that can help you manage and reduce this risk.
1. Kaufman Hall. The Effect of COVID-19 on Hospital Financial Health. July 2020. kaufmanhall.com/sites/default/files/documents/2020-07/Effect-COVID19-Financial-Health_KaufmanHall.pdf. Accessed May 20, 2021.
2. American Hospital Association. Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. https://www.aha.org/standardsguidelines/2020-04-17-roadmap-aha-others-safely-resuming-elective-surgery-covid-19-curve. Accessed May 20, 2020.
3. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;1:59-74.
4. Shepard J, Ward W, Milstone A, Carlson T, Frederick J, Hadhazy E, Perl T. Financial impact of surgical site infections on hospitals: the hospital management perspective. JAMA Surg. 2013;148(10):907-914.
5. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Healthcare infection control practices advisory committee. Centers for Disease Control and Prevention guideline for the prevention of surgical site
infection, 2017. eAppendix 2. JAMA Surg. Published online May 3, 2017.
6. Stone PW. Changes in Medicare reimbursement for hospital-acquired conditions including infections. Am J Infect Control. 2009;37:17A-18A.
7. Centers for Disease Control and Prevention. cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed May 20, 2021.