Michael K Dalton1, Christer Mjåset2,3,4, Adoma Manful5, Melvin D Helgeson6, William Wynn-Jones5,4, Zara Cooper5, Tracey P Koehlmoos7, Joel S Weissman5. 1. Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, 1 Brigham Circle, Boston, MA, 02120, USA. mdalton9@bwh.harvard.edu. 2. Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. 3. Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, PO Box 4950, Nydalen, 0424, Oslo, Norway. 4. Commonwealth Fund Harkness Fellowship, 1 East 75th Street, New York, NY, 10021, USA. 5. Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, 1 Brigham Circle, Boston, MA, 02120, USA. 6. Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA. 7. F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20184, USA.
Abstract
INTRODUCTION: Bundled payments for spine surgery, which is known for having high overall cost with wide variation, have been previously studied in older adults. However, there has been limited work examining bundled payments in working-age patients. We sought to identify the variation in the cost of spine surgery among working age adults in a large, national insurance claims database. METHODS: We queried the TRICARE claims database for all patients, aged 18-64, undergoing cervical and non-cervical spinal fusion surgery between 2012 and 2014. We calculated the case mix adjusted, price standardized payments for all aspects of care during the 60-, 90-, and 180-day periods post operation. Variation was assessed by stratifying Hospital Referral Regions into quintiles. RESULTS: After adjusting for case mix, there was significant variation in the cost of both cervical ($10,538.23, 60% of first quintile) and non-cervical ($20,155.59, 74%). Relative variation in total cost decreased from 60- to 180-days (63 to 55% and 76 to 69%). Index hospitalization was the primary driver of costs and variation for both cervical (1st-to-5th quintile range: $11,033-$19,960) and non-cervical ($18,565-$36,844) followed by readmissions for cervical ($0-$11,521) and non-cervical ($0-$13,932). Even at the highest quintile, post-acute care remained the lowest contribution to overall cost ($2070 & $2984). CONCLUSIONS: There is wide variation in the cost of spine surgery across the United States for working age adults, driven largely by index procedure and readmissions costs. Our findings suggest that implementing episodes longer than the current 90-day standard would do little to better control cost variation.
INTRODUCTION: Bundled payments for spine surgery, which is known for having high overall cost with wide variation, have been previously studied in older adults. However, there has been limited work examining bundled payments in working-age patients. We sought to identify the variation in the cost of spine surgery among working age adults in a large, national insurance claims database. METHODS: We queried the TRICARE claims database for all patients, aged 18-64, undergoing cervical and non-cervical spinal fusion surgery between 2012 and 2014. We calculated the case mix adjusted, price standardized payments for all aspects of care during the 60-, 90-, and 180-day periods post operation. Variation was assessed by stratifying Hospital Referral Regions into quintiles. RESULTS: After adjusting for case mix, there was significant variation in the cost of both cervical ($10,538.23, 60% of first quintile) and non-cervical ($20,155.59, 74%). Relative variation in total cost decreased from 60- to 180-days (63 to 55% and 76 to 69%). Index hospitalization was the primary driver of costs and variation for both cervical (1st-to-5th quintile range: $11,033-$19,960) and non-cervical ($18,565-$36,844) followed by readmissions for cervical ($0-$11,521) and non-cervical ($0-$13,932). Even at the highest quintile, post-acute care remained the lowest contribution to overall cost ($2070 & $2984). CONCLUSIONS: There is wide variation in the cost of spine surgery across the United States for working age adults, driven largely by index procedure and readmissions costs. Our findings suggest that implementing episodes longer than the current 90-day standard would do little to better control cost variation.
Entities:
Keywords:
Bundled payments; Episode of care; Payment reform; Spine surgery
Authors: Lindsay E Jubelt; Keith S Goldfeld; Wei-yi Chung; Saul B Blecker; Leora I Horwitz Journal: JAMA Intern Med Date: 2016-01 Impact factor: 21.873
Authors: Daniel J Gottlieb; Weiping Zhou; Yunjie Song; Kathryn Gilman Andrews; Jonathan S Skinner; Jason M Sutherland Journal: Health Aff (Millwood) Date: 2010-01-28 Impact factor: 6.301
Authors: Amol S Navathe; Andrea B Troxel; Joshua M Liao; Nan Nan; Jingsan Zhu; Wenjun Zhong; Ezekiel J Emanuel Journal: JAMA Intern Med Date: 2017-02-01 Impact factor: 21.873
Authors: John D Birkmeyer; Cathryn Gust; Onur Baser; Justin B Dimick; Jason M Sutherland; Jonathan S Skinner Journal: Health Serv Res Date: 2010-12 Impact factor: 3.402
Authors: Laura A Dummit; Daver Kahvecioglu; Grecia Marrufo; Rahul Rajkumar; Jaclyn Marshall; Eleonora Tan; Matthew J Press; Shannon Flood; L Daniel Muldoon; Qian Gu; Andrea Hassol; David M Bott; Amy Bassano; Patrick H Conway Journal: JAMA Date: 2016-09-27 Impact factor: 56.272