Anesthesia groups carry direct exposure on three fronts where intraoperative hypotension is the most-cited modifiable driver: malpractice claims (where IOH and its downstream complications are disproportionately represented), value-based-care contracts with payors (where outcome-quality clauses tie back to readmissions and complications), and the documentation cycle around CMS PSI-10 (postop AKI requiring dialysis). Until now there’s been no facility-comparable view of which IOH events are happening, why, and where. LINCR runs that audit on case data your AIMS already produces.
For each facility in your portfolio: total IOH-event volume, cause distribution (vasodilation, hypovolemia, myocardial depression, bradycardia), case-mix and procedure-type segmentation, trend over time. Surfaces the cases and case-types most heavily contributing to the group’s IOH burden. Protocol-change recommendations are clinical decisions for your medical leadership; the audit produces the underlying pattern data.
Case-mix-normalized IOH burden per anesthesiologist with cause distribution and example cases attached. Defensible, evidence-grounded input for medical-director review and credentialing-cycle conversations.
Audit reports your QI committee, hospital quality department, and malpractice carrier can point to as evidence of structured QI activity that identified a pattern, attributed cause, and recommended protocol response. Useful for malpractice carrier review, VBC contract reporting, MOC quality-improvement evidence, and exception/appeal filings around PSI-10 specifically.
Per-case cost ranges from peer-reviewed literature for the four downstream outcome categories most strongly linked to intraoperative hypotension:
| Outcome | Incidence | IOH risk multiplier | Per-case cost |
|---|---|---|---|
| Postoperative AKI | 18–39% | +60% | $4,400 (stage 1) — $46,500 (stage 3) |
| MINS (myocardial injury after non-cardiac surgery) | 18–20% in ≥45 yo | +30% | $10,000 — $25,000 |
| Extended LOS / 30-day readmission | 37.5% surgical pts | +0.18 days avg | $2,000 — $5,000 / extra day |
| Discharge to skilled nursing | 22.1% vs 18.1% | +22% relative | $8,000 — $15,000 / SNF admission |
Anesthesia-related malpractice claims disproportionately involve IOH and its downstream complications. Documented QI activity reduces forward risk-adjusted exposure and is increasingly priced by carriers. Most direct relevance.
Value-based-care contracts with payors increasingly carry outcome-quality clauses tied to readmission and complication rates. Audit findings are documentable evidence of the quality-improvement activity those contracts assume.
PSI-10 is the AHRQ safety indicator for postoperative AKI requiring dialysis — one of 10 components of the PSI-90 composite. Audit findings document structured QI activity targeting the IOH driver of PSI-10, useful for exception filings, internal review, and credentialing-cycle conversations.
PSI-90 contributes ~35% of HACRP scoring (the rest is CDC NHSN infections) and feeds HVBP. IOH is one of multiple PSI-10 drivers; the audit’s impact on HACRP/HVBP is indirect and depends on case mix, protocol response, and the gap between current and post-implementation IOH burden.
Exposure figures are population-level estimates from peer-reviewed literature (Walsh 2013, Sun 2015, Smilowitz 2017, Sessler 2019, Ghaferi 2009; HACRP / HVBP figures from CMS FY 2025 IPPS Final Rule). LINCR’s audit quantifies and characterizes the IOH-event burden in your facility’s case data. It does NOT claim direct AKI prevention or direct improvement in PSI-10 / PSI-90 / HACRP / HVBP scores. The documented chain is: IOH burden is associated in the literature with elevated risk of AKI, MINS, LOS, and SNF discharge; cause-attributed analysis enables clinical leadership to design protocol changes targeted at the dominant IOH driver in their case mix; whether those protocol changes reduce downstream complications at the facility level is an empirical outcome that requires post-implementation measurement, not an audit deliverable. IMPROVE-multi (n=8,520, 2025) showed individualized BP targeting alone did not reduce these outcomes; LINCR’s thesis is that cause-attribution rather than BP-targeting is the right intervention layer, but that thesis itself awaits prospective validation (the M3–M6 prospective stratifier and the Y2–Y3 real-time CDS will produce that evidence).
Security posture: HIPAA-compliant, BAA-ready, on-prem deployment is the default and what the architecture was designed for. Hospital data does not leave the appliance — we do not require it for any product layer through M12. SOC 2 Type 1 evidence collection in flight. The audit product (and the prospective risk-stratifier in months 3–6) ships under the FD&C Act §520(o)(1)(E) clinical-decision-support carve-out (21st Century Cures); does not require 510(k).
| Buyer | Annual contract value |
|---|---|
| Anesthesia management company | $25K–$100K per facility |
| Ambulatory surgery center | $50K–$200K |
| Community hospital | $100K–$500K |
| Large hospital system | $500K–$2M |
Pricing scales with facility surgical volume and number of facilities under contract. The 90-day retrospective audit at the first facility is at no cost during the pilot phase; the audit findings are yours regardless of whether the contract proceeds. Annual contracts include quarterly audit refreshes, the prospective risk-stratifier as it ships in months 3–6 of the contract year, and direct access to clinical-engineering support for protocol-change implementation.
Live demo running the audit against the MOVER dataset (UC Irvine, 55,483 anesthesia cases, JAMIA Open 2023). One representative case with five IOH events spanning four different cause attributions, plus the aggregate distribution across 300 randomly sampled cases. Same workflow on your facility’s data, at scale.
If your facility’s IOH burden isn’t fully characterized in current quality reporting — and the malpractice-relations or VBC reporting cycle would benefit from documented cause-attributed analysis — this is worth one structured call. We’ll walk through the audit deliverable shape, answer procurement and security questions, and scope a 90-day pilot at one facility.
Email anish@lincr.io