Impact of nearby hospital closure on case volume and patient mix of established surgical services
*Madeline Goosman MPH, *Tynan H. Friend BA, Daithi S. Heffernan , *Andrew H. Stephen MD, FACS
Brown University, Providence, RI
BACKGROUND: Financial stress, acquisitions and consolidation of regional hospitals has resulted in a growing number of hospital closures, often occurring in areas with vulnerable populations. However, little is known regarding specific impacts at centers nearest to those hospitals that were forced to close. We examined the effect of the closure of an urban hospital on the surgical volume and payor mix at both a Neighboring Community hospital (NCH) and a state trauma center (TC).
STUDY DESIGN: Retrospective review of surgical volume at the NCH and TC before and after the 2017 closure of a neighboring urban hospital. Patient demographics, private health insurance status (BCBS, United) versus state sponsored insurance (Neighborhood Health Plan Rhode Island (NHP RI)), case volume and characteristics, and weekend/holiday presentations were reviewed. Essential surgical procedures were defined as lap cholecystectomy, lap appendectomy, and incision and drainage. Data were categorized by the zip codes served by the NCH and TC.
RESULTS The number of total operations increased by 2.9% at the NCH and decreased 3.5% at the TC. Essential surgical cases increased by 20.2% at the NCH and decreased by 11.6% at the TC. Both hospitals experienced an increase in holiday/weekend surgical cases with NCH experiencing a 15.8% increase and TC experiencing a 10.3% increase. At both the NCH and TC these additional patients were more likely to be covered by NHP RI rather than by private insurance. At the NCH and TC, patients from the zip codes previously served by the closed hospital were more likely to contribute to the increase in holiday/weekend cases. Across the NCH and TC, there was a positive correlation between the increase in essential surgeries per year after the closure and patients having NHP RI health insurance (F(1,67) = 22.6; p<0.001)). Further, after the closure of the neighboring hospital, there was a greater percentage of surgeries covered by NHP RI among cases from the zip codes that were covered by the closed hospital compared to others (10.2% and 3.5%; p=0.025). At the TC, these differences were not significant (before closure: 5.6% and 4.2%; p=0.29; after closure: 6.4% and 4.1%; p=0.2). There were no significant differences between the percentage of surgeries covered by private insurance at either NCH or TC before or after nearby hospital closure (NCH before: 4.6% and 4.3%; p=0.7; NCH after: 4.9% and 4.3%; p=0.57; TC before: 3.2% and 4.5%; p=0.36; TC after: 3.4% and 4.5%; p=0.2).
CONCLUSIONS. The closure of NCHs results in disproportionate increases in off-hours surgery for patients with lower-reimbursing insurance plans. These findings can inform resource mobilization, such as operating room and surgeon staffing for remaining, often safety-net hospitals.
Surgical cases before and after nearby hospital closure
Before Hospital Closure | After Hospital Closure | |||
N or Mean | % or Standard Deviation | N or Mean | % or Standard Deviation | |
Total Number of Surgical Cases Per Year | ||||
NCH | 8328.9 | 8572.6 | ||
TC | 15435.4 | 14890.6 | ||
Number of Essential Surgical Cases Per Year | ||||
NCH | 469.7 | 5.6% | 564.7 | 6.6% |
TC | 741.6 | 4.8% | 655.3 | 4.4% |
Number of Essential Surgical Cases Per Year (NCH and TC combined) | ||||
Zip Codes Served By Closed Hospital (n = 3) | 182.3 | 15.0% | 254.0 | 20.8% |
Other Zip Codes (n = 20) | 1028.9 | 85.0% | 966.0 | 79.2% |
Number of Holiday/Weekend Surgical Cases Per Year | ||||
NCH | 500.4 | 6.0% | 579.3 | 6.8% |
TC | 1536.9 | 10.0% | 1695.0 | 11.4% |
Mean Number of Surgeries Covered by NHP RI Per Year at NCH | ||||
Zip Codes Served By Closed Hospital (n = 3) | 30.6 | 13.9 | 42.9 | 18.3 |
Other Zip Codes (n = 20) | 13.0 | 8.8 | 14.6 | 10.0 |
Mean Number of Surgeries Covered by NHP RI Per Year at TC | ||||
Zip Codes Served By Closed Hospital (n = 3) | 52.7 | 29.5 | 59.5 | 23.2 |
Other Zip Codes (n = 20) | 39.3 | 32.6 | 37.8 | 31.7 |
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