The financial value of vascular surgeons as operative consultants to other surgical specialties

• Published in: Journal of vascular surgery Vol. 69; no. 4; pp. 1314 - 1321
• Main Authors: Johnson, Cali E., Manzur, Miguel F., Wilson, Todd A., Brown Wadé, Niquelle, Weaver, Fred A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2019
• Subjects: Adult; Aged; Consultants; Contribution margin; Cost analysis; Female; Hospital Charges; Hospital Costs; Humans; Male; Middle Aged; Operative consults; Patient Care Team - economics; Referral and Consultation - economics; Retrospective Studies; Specialization - economics; Surgeons - economics; Vascular surgery; Vascular Surgical Procedures - economics; Contribution margin; Vascular surgery; Cost analysis; Operative consults
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2018.07.035

Vascular surgeons provide assistance to other surgical specialties through planned and unplanned joint operative cases. The financial impact to the hospital of vascular surgeons as consultants in this context has yet to be quantified. We sought to quantify the financial value of services provided by consulting vascular surgeons in the performance of joint operative procedures, both planned and unplanned.
Hospital financial data were reviewed for all inpatient operative cases during a 3-year period (2013-2015). Cases in which a vascular surgeon provided operative assistance as a consultant to a nonvascular surgeon were identified and designated planned or unplanned. Contribution margin, defined as hospital revenue minus variable cost, was determined for each case. In addition, the contribution margin ratio (contribution margin divided by revenue) was determined for each cohort. Financial data for consulting cases was compared with all nonconsult cases. Data analysis was performed with nonparametric statistics.
There were 208 cases with a primary nonvascular surgeon that required a vascular co-surgeon during the study period, 169 planned and 39 unplanned. For comparison, 19,594 nonconsult cases of other surgical specialties were identified. The median contribution margin was higher for vascular surgery consult cases compared with nonconsult cases ($14,406 [interquartile range, $63,192] vs $5491 [interquartile range $28,590]; P = .002). The overall contribution margin ratio was higher for vascular surgery consult cases (0.41) compared with control nonconsult cases (0.35). There was no difference in contribution margin and contribution margin ratio between planned and unplanned vascular surgery consult cases.
Vascular surgeons provide essential operative assistance to other surgical specialties. This operative assistance is frequent and provides significant financial value, with high contribution margin and contribution margin ratio. Vascular surgeons, as consulting surgeons, enable the completion of highly complex cases and in this capacity provide significant financial value to the hospital.