Analysis of Factors Relevant to Revenue Enhancement in Hernia Interventions (SwissDRG G09)

Abstract

Background: Since diagnosis-related groups (SwissDRG) were established in Switzerland in 2012, small and medium-size hospitals have encountered increasing financial troubles. Even though hernia repair operations are frequent, most hospitals fail to cover their costs with these procedures. Previous studies have focused mainly on analyzing costs and the contributing factors but less on variables that can be positively influenced. Therefore, this study aims to identify the relevant and influenceable factors for revenue growth in hernia repair surgery. Methods: Data from all patients who underwent the SwissDRG G09 surgery for a hernia in 2019 were analyzed. The contribution margin (CM4), as well as any over- or under-coverage, was correlated to case-specific costs. Results: A total of 168 patients received hernia repair surgery with the SwissDRG code G09. The average revenue/loss generated by one procedure was CHF −623.84. Procedures covered by the General Health Insurance (OKP) generated a loss of CHF −830.70 on average, whereas procedures covered by private insurance companies (VVG) generated revenue of CHF +1100 on average. Significant factors impacting the profitability of hernia repair operations were teaching during surgery (p < 0.005), the surgical operating time (p < 0.001), the total anesthesia time (p < 0.001), the number of surgeons present (p = 0.022), the insurance state of patients (p < 0.001), and the type of surgery (p < 0.01 for Lichtenstein’s procedure). Conclusions: This study reveals that hernia repair surgery performed under cost coverage by OKP is generally unprofitable. Our results further imply that the most important and influenceable factors for revenue enhancement are the quality and process optimization of the surgical department. To compensate for this deficit, hospitals should aim to increase the percentage of patients with private health insurance coverage in their procedures. Since outpatient surgery does not provide a valid alternative due to the low reimbursement by insurance companies, the cost efficiency of inpatient hernia repair needs to be increased by process optimization of the surgical department; for instance, by providing specialized hernia teams performing with shorter operation times and high quality.

Analysis of Factors Relevant to Revenue Improvement in Ventral Hernia Repair, Their Influence on Surgical Training, and Development of Predictive Models: An Economic Evaluation

“…Differences between these statuses are the coverage of extra services, which means the patient is entitled to a double bedroom (semi-private) or a single bedroom (private) and can choose their treating physician [ 18 ]. We obtained the variables from the controlling department’s internal data processing system and correlated these with the contribution margin (CM4) [ 18 , 21 ] of individual procedures. The CM4 value indicates a possible over or under-coverage relating to case-specific costs [ 18 , 21 ].…”

“…Development of hypothesis. In an analysis we previously published [ 18 ], we were able to demonstrate that it is possible to increase the yield of inguinal hernia care in the SwissDRG system independently of comorbidities through process optimization and quality improvement [ 18 ]. Surgical operating time, the total anesthesia time, the number of surgeons present, the insurance state of patients, and surgical technique were identified as vital factors that can increase returns [ 18 ].…”

“…After reviewing the existing literature [ 3 , 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] and following our previous publication [ 18 ], our hypothesis states that primary ventral hernias and incisional hernias must be analyzed separately, and that ventral hernia repair in the SwissDRg system is deficient, but that an increase in yield is possible [ 18 ]. We postulated that individual operations suitable for teaching could be identified.…”

“…In addition, a predictive model will be developed to determine which combination of factors could lead to a financial loss and which countermeasures may be employed to minimize losses. The combination of all the measures mentioned above for preoperative optimization [ 3 , 17 , 19 ] including the predictive algorithm, process optimization, and quality improvement [ 3 , 18 , 19 , 20 ] could be used to increase yields significantly. The literature reviewed confirms this hypothesis [ 3 , 17 , 18 , 19 , 20 ].…”

“…The combination of all the measures mentioned above for preoperative optimization [ 3 , 17 , 19 ] including the predictive algorithm, process optimization, and quality improvement [ 3 , 18 , 19 , 20 ] could be used to increase yields significantly. The literature reviewed confirms this hypothesis [ 3 , 17 , 18 , 19 , 20 ]. For this purpose, we analyzed primary ventral and incisional hernias separately as described above [ 6 , 11 , 12 , 13 , 14 , 15 , 16 ] based on their contribution margins (in this case CM4) [ 21 ].…”