Jeffrey L Gum1, Breton Line2, Leah Y Carreon3, Richard A Hostin4, Samrat Yeramaneni4, Steven D Glassman1, Douglas L Burton5, Justin S Smith6, Christopher I Shaffrey7, Peter G Passias8, Virginie Lafage9, Christopher P Ames10, R Shay Bess2. 1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA. 2. Presbyterian/St. Luke's Medical Center, Rocky Mountain Hospital for Children, Denver, CO, USA. 3. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA. leah.carreon@nortonhealthcare.org. 4. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA. 5. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA. 6. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. 7. Department of Orthopaedic Surgery, Spine Division, Duke University Medical Center, Durham, NC, USA. 8. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA. 9. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA. 10. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Abstract
STUDY DESIGN: Retrospective multicenter cost analysis. OBJECTIVE: To (1) determine if index episode of care (iEOC) costs of Adult Spinal Deformity (ASD) surgeries are below the Medicare Allowable (MA) threshold, and (2) identify variables that can predict iEOC cases that are below MA. Previous studies have suggested that actual direct hospital cost of Adult Spinal Deformity (ASD) surgery is higher than Medicare Allowable (MA) rates, which has become the benchmark reimbursement target for hospital accounting systems. METHODS: From a prospective, multicenter ASD surgical database, patients undergoing long instrumented fusions (> 5 level) with cost data were identified. iEOC cost was calculated utilizing actual direct hospital cost. MA rates were calculated using hospital specific, year-appropriate CMS Inpatient Pricer Payment System. Recursive partitioning identified potentially modifiable variables that can predict iEOC cost < MA. RESULTS: Administrative direct cost data from 210 patients were obtained from 4 of 11 centers. Ninety-five (45%) patients had iEOC cost < MA. There was significant variation across the four centers in both iEOC cost ($56,788-$78,878, p < 0.0001) and reimbursement ($40,623-$91,351, p < 0.0001) across deformity-specific DRGs (453,454,456,457). Academic centers were more likely to have iEOC costs < MA (67.2% vs 8.9%, p < 0.0001). Recursive partitioning (r2 = 0.309) identified rhBMP-2 use of < 24 mg, sagittal plane deformity, a combined anterior/posterior approach, and an SF36-MCS < 39 as predictive for iEOC cost < MA. Performing an anterior/posterior approach reimburses between 14.7% and 121.1% more (2.2-fold) than posterior-only approach. This change in DRG allows iEOC cost to be more likely below the MA threshold. CONCLUSION: There is significant institutional (private vs academic) variation in ASD reimbursement. BMP use, deformity type, approach, and baseline mental health impact ASD surgery cost being below Medicare reimbursement. ASD surgeries with anterior/posterior approaches are in DRGs that can potentially reimburse 2.2-fold the posterior-only surgery, making it more likely to fall below the MA threshold. LEVEL OF EVIDENCE: III.
STUDY DESIGN: Retrospective multicenter cost analysis. OBJECTIVE: To (1) determine if index episode of care (iEOC) costs of Adult Spinal Deformity (ASD) surgeries are below the Medicare Allowable (MA) threshold, and (2) identify variables that can predict iEOC cases that are below MA. Previous studies have suggested that actual direct hospital cost of Adult Spinal Deformity (ASD) surgery is higher than Medicare Allowable (MA) rates, which has become the benchmark reimbursement target for hospital accounting systems. METHODS: From a prospective, multicenter ASD surgical database, patients undergoing long instrumented fusions (> 5 level) with cost data were identified. iEOC cost was calculated utilizing actual direct hospital cost. MA rates were calculated using hospital specific, year-appropriate CMS Inpatient Pricer Payment System. Recursive partitioning identified potentially modifiable variables that can predict iEOC cost < MA. RESULTS: Administrative direct cost data from 210 patients were obtained from 4 of 11 centers. Ninety-five (45%) patients had iEOC cost < MA. There was significant variation across the four centers in both iEOC cost ($56,788-$78,878, p < 0.0001) and reimbursement ($40,623-$91,351, p < 0.0001) across deformity-specific DRGs (453,454,456,457). Academic centers were more likely to have iEOC costs < MA (67.2% vs 8.9%, p < 0.0001). Recursive partitioning (r2 = 0.309) identified rhBMP-2 use of < 24 mg, sagittal plane deformity, a combined anterior/posterior approach, and an SF36-MCS < 39 as predictive for iEOC cost < MA. Performing an anterior/posterior approach reimburses between 14.7% and 121.1% more (2.2-fold) than posterior-only approach. This change in DRG allows iEOC cost to be more likely below the MA threshold. CONCLUSION: There is significant institutional (private vs academic) variation in ASD reimbursement. BMP use, deformity type, approach, and baseline mental health impact ASD surgery cost being below Medicare reimbursement. ASD surgeries with anterior/posterior approaches are in DRGs that can potentially reimburse 2.2-fold the posterior-only surgery, making it more likely to fall below the MA threshold. LEVEL OF EVIDENCE: III.
Authors: Omar M Uddin; Raqeeb Haque; Patrick A Sugrue; Yousef M Ahmed; Tarek Y El Ahmadieh; Joel M Press; Tyler Koski; Richard G Fessler Journal: J Neurosurg Spine Date: 2015-08-28
Authors: Samrat Yeramaneni; Christopher P Ames; Shay Bess; Doug Burton; Justin S Smith; Steven Glassman; Jeffrey L Gum; Leah Carreon; Amit Jain; Corinna Zygourakis; Ioannis Avramis; Richard Hostin Journal: Spine J Date: 2018-03-22 Impact factor: 4.166
Authors: Corinna C Zygourakis; Caterina Y Liu; Malla Keefe; Christopher Moriates; John Ratliff; R Adams Dudley; Ralph Gonzales; Praveen V Mummaneni; Christopher P Ames Journal: Neurosurgery Date: 2018-03-01 Impact factor: 4.654
Authors: Jeffrey L Gum; Richard Hostin; Chessie Robinson; Michael P Kelly; Leah Yacat Carreon; David W Polly; R Shay Bess; Douglas C Burton; Christopher I Shaffrey; Justin S Smith; Virginie LaFage; Frank J Schwab; Christopher P Ames; Steven D Glassman Journal: Spine J Date: 2016-08-11 Impact factor: 4.166
Authors: Peter G Passias; Cyrus M Jalai; Nancy Worley; Shaleen Vira; Bryan Marascalchi; Shearwood McClelland; Virginie Lafage; Thomas J Errico Journal: Spine Deform Date: 2017-09
Authors: Thomas M O'Lynnger; Scott L Zuckerman; Peter J Morone; Michael C Dewan; Raul A Vasquez-Castellanos; Joseph S Cheng Journal: Neurosurgery Date: 2015-10 Impact factor: 4.654