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Surgical efficiency increases, revenue falls with Hurricane Katrina

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Hurricane Katrina brought many changes to hospitals that remained open throughout the hurricane and during its aftermath. Among these were greater efficiency as more surgeries were performed with fewer staff, and declining revenue because of changes in payer mix and increased numbers of uninsured patients.

According to senior author Dr. William S. Richardson and associates at the Ochsner Clinic Foundation in New Orleans, 11 major hospitals in the New Orleans area closed in the storm’s aftermath. Three hospitals, including their own, remained open and functional.

Their goal, as stated in their paper in the Journal of the American College of Surgery for September, was to document the effect of Katrina on routine surgery, using laparoscopic cholecystectomy as a representative case.

The authors compared the time periods encompassing the 7 months prior to Katrina and the 7 months following, starting 3 months after the storm when operating room volumes had regained their capacity. As recorded in a prospectively collected database, 196 prestorm and 167 poststorm cases underwent outpatient laparoscopic cholecystectomy, and 62 prestorm and 64 poststorm cases had inpatient laparoscopic cholecystectomy.

Perhaps the biggest change was the loss of staff, from 129 to 90 full-time equivalents, primarily in sterile processing, recovery room, pre-and postoperative `holding. Nonetheless, operative time, length of stay, and turnover time did not change markedly.

Although the loss in staff resulted in decreased costs, a decrease in privately insured patients and increases in Medicare, Medicaid, and noninsured patients led to revenue losses. Reimbursement decreased from 43.7% to 41.4%.

“Our sound disaster planning (and fortunate geographic location) allowed us to weather the storm successfully and emerge as one of the few fully functional hospitals in the area,” Dr. Richardson’s team maintains.

Their storm preparedness meant that their supply lines were not compromised, so instrumentation, procedures, and processing did not change. They were able to house and feed staff whose homes had been destroyed.

Since the hurricane, the hospital has increased their emergency preparedness efforts by purchasing ham radios, increasing clean-water well capacity, and reinforcing generators. They also developed strong contracts with fuel suppliers, and contracted with an out-of-state security company for the next storm.

“In planning for this type of disaster,” the authors recommend that hospitals “be ready for large staff turnovers, a potential increase in uninsured patients, a diminished employment pool, and decreases in outpatient surgery.”

J Am Coll Surg 2009;209;352-355.