scholarly journals Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery

2017 ◽  
Vol 43 (6) ◽  
pp. E11 ◽  
Author(s):  
Pierce D. Nunley ◽  
Gregory M. Mundis ◽  
Richard G. Fessler ◽  
Paul Park ◽  
Joseph M. Zavatsky ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Diagnosis Related Group ◽  
Anterior Fusion ◽  
Private Institutions ◽  
Academic Institutions ◽  
Related Group ◽  
Case Type ◽  
Type 3

OBJECTIVEThe aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery.METHODSMedicare’s Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion.RESULTSPooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay.CONCLUSIONSReimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.

scholarly journals Severity variations within DRGs:Measurement of hospital effects by use of data on significant secondary diagnoses

1998 ◽  
Vol 21 (1) ◽  
pp. 37 ◽  
Author(s):  
Don Hindle ◽  
Pieter Degeling ◽  
Ono Van Der Wel
Keyword(s):  
Resource Allocation ◽  
Length Of Stay ◽  
Group Classification ◽  
Public Hospitals ◽  
Diagnosis Related Group ◽  
Use Of Data ◽  
Acute Hospitals ◽  
Related Group

The Diagnosis Related Group classification has provided an excellent basis forenhancing the equity of resource allocation between public acute hospitals. However,it underestimates the higher levels of severity and consequent costliness of referralhospitals.This paper describes a practical way of measuring within-DRG variations in severity,which can be used to increase the precision of casemix-based funding. It involves theregression of length of stay against the numbers of significant diagnoses and procedures,and hence the prediction of additional justified costs. An example is given of itsapplication to data from South Australian public hospitals.

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

97. Complications following adult spinal deformity impact length of stay and are driven by intervention severity and can be predicted using a weighted score

2020 ◽  
Vol 20 (9) ◽  
pp. S47
Author(s):  
Eric O. Klineberg ◽  
Renaud Lafage ◽  
Virginie Lafage ◽  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Weighted Score

313. Risk factors for increased length of stay, reoperation and readmission following adult spinal deformity surgery in the elderly

2019 ◽  
Vol 19 (9) ◽  
pp. S152
Author(s):  
Paramjit Singh ◽  
John Ibrahim ◽  
Deeptee Jain ◽  
Paul Eichenseer ◽  
Mayur Kardile ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
The Elderly ◽  
Spinal Deformity Surgery ◽  
Surgery In The Elderly

Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity

Neurosurgery ◽  
2017 ◽  
Vol 82 (3) ◽  
pp. 378-387 ◽  
Author(s):  
Corinna C Zygourakis ◽  
Caterina Y Liu ◽  
Malla Keefe ◽  
Christopher Moriates ◽  
John Ratliff ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Severity Of Illness ◽  
Total Hospital Cost ◽  
Median Income ◽  
Cost Variation ◽  
Time Period ◽  
Spinal Deformity Surgery ◽  
The Mean

Abstract BACKGROUND Several studies suggest significant variation in cost for spine surgery, but there has been little research in this area for spinal deformity. OBJECTIVE To determine the utilization, cost, and factors contributing to cost for spinal deformity surgery. METHODS The cohort comprised 55 599 adults who underwent spinal deformity fusion in the 2001 to 2013 National Inpatient Sample database. Patient variables included age, gender, insurance, median income of zip code, county population, severity of illness, mortality risk, number of comorbidities, length of stay, elective vs nonelective case. Hospital variables included bed size, wage index, hospital type (rural, urban nonteaching, urban teaching), and geographical region. The outcome was total hospital cost for deformity surgery. Statistics included univariate and multivariate regression analyses. RESULTS The number of spinal deformity cases increased from 1803 in 2001 (rate: 4.16 per 100 000 adults) to 6728 in 2013 (rate: 13.9 per 100 000). Utilization of interbody fusion devices increased steadily during this time period, while bone morphogenic protein usage peaked in 2010 and declined thereafter. The mean inflation-adjusted case cost rose from $32 671 to $43 433 over the same time period. Multivariate analyses showed the following patient factors were associated with cost: age, race, insurance, severity of illness, length of stay, and elective admission (P < .01). Hospitals in the western United States and those with higher wage indices or smaller bed sizes were significantly more expensive (P < .05). CONCLUSION The rate of adult spinal deformity surgery and the mean case cost increased from 2001 to 2013, exceeding the rate of inflation. Both patient and hospital factors are important contributors to cost variation for spinal deformity surgery.

scholarly journals Factors Associated With Short Length of Stay After Long Fusions for Adult Spinal Deformity: Initial Steps Toward Developing an Enhanced Recovery Pathway

2020 ◽  
pp. 219256822094144
Author(s):  
Francis Lovecchio ◽  
Michael Steinhaus ◽  
Jonathan Charles Elysee ◽  
Alex Huang ◽  
Bryan Ang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Spinal Deformity ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Spinal Deformity ◽  
Clinical Care ◽  
Medical Complication ◽  
Factors Associated ◽  
Estimated Blood Loss

Study Design: Retrospective cohort study. Objectives: The identification of case types and institutional factors associated with reduced length of stay (LOS) is a key initial step to inform the creation of clinical care pathways that can assist hospitals to maximize the benefit of value-based payment models. The objective of this study was to identify preoperative, intraoperative, and postoperative factors associated with shorter than expected LOS after adult spinal deformity (ASD) surgery. Methods: A retrospective cohort study was performed of 82 patients with ASD who underwent ≥5 levels of fusion to the pelvis between 2013 and 2018. A LOS <6 days was determined as a basis for comparison, as 5.7 days was the “expected LOS” generated through Poisson regression modeling of the sample. Clinical, radiographic, surgical, and postoperative factors were compared between those staying ≥6 days (L group) and <6 days (S group). Logistic regression was used to identify factors associated with LOS <6 days. Results: A total of 35 patients were in group S (42.7%). Gender, age, body mass index, ASA (American Society of Anesthesiologists) class, and use of preoperative narcotics, revision surgery, day of admission, and surgical complications did not vary between the cohorts ( P > .05). Mild-moderate preoperative sagittal deformity (sagittal Schwab modifiers 0 or +), lower estimated blood loss (<1200 mL), fewer levels fused (7 vs 10 levels), shorter operating room time, procedure end time before 15:00, and no intensive care unit stay, were associated with short LOS ( P < .05). Only 1 major medical complication occurred in the short LOS group ( P < .05). Conclusions: This study identifies the ASD “case phenotype,” intra-, and postoperative benchmarks associated with shorter LOS, providing targets for pathways designed to reduce LOS.

scholarly journals Predictors for Non-Home Patient Discharge Following Elective Adult Spinal Deformity Surgery

2017 ◽  
Vol 8 (3) ◽  
pp. 266-272 ◽  
Author(s):  
John Di Capua ◽  
Sulaiman Somani ◽  
Nahyr Lugo-Fagundo ◽  
Jun S. Kim ◽  
Kevin Phan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Deformity ◽  
Multivariate Regression ◽  
Adult Spinal Deformity ◽  
Patient Discharge ◽  
Hospital Length Of Stay ◽  
Significant Variable ◽  
Discharge Destination ◽  
Improvement Program ◽  
Home Discharge

Study Design: Retrospective cohort study. Objectives: Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. The utilization of spinal surgery has increased and this trend is expected to continue. To effectively deal with an increasing patient volume, identifying variables associated with patient discharge destination can expedite placement and reduce length of stay. Methods: The 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision diagnosis codes relevant to ASD. Patients were divided based on discharge destination. Bivariate and multivariate logistic regression analyses were employed to identify predictors for patient discharge destination and hospital length of stay. Results: A total of 4552 patients met inclusion criteria, of which 1102 (24.2%) had non-home discharge. Multivariate regression revealed total relative value unit (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.00-1.01); female sex (OR = 1.54, 95% CI = 1.32-1.81); American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander versus black race (OR = 0.52, 95% CI = 0.35-0.78, P = .002); age ≥65 years (OR = 3.72, 95% CI = 3.19-4.35); obesity (OR = 1.18, 95% CI = 1.01-1.38, P = .034); partially/totally functionally dependent (OR = 2.11, 95% CI = 1.49-2.99); osteotomy (OR = 1.42, 95% CI = 1.12-1.80, P = .004) pelvis fixation (OR = 2.38, 95% CI = 1.82-3.11); operation time ≥4 hours (OR = 1.74, 95% CI = 1.47-2.05); recent weight loss (OR = 7.66, 95% CI = 1.52-38.65; P = .014); and American Society of Anesthesiologists class ≥3 (OR = 1.80, 95% CI = 1.53-2.11) as predictors of non-home discharge. P values were <.001 unless otherwise noted. Additionally, multivariate regression found non-home discharge to be a significant variable in prolonged length of stay. Conclusions: The authors suggest these results can be used to inform patients preoperatively of expected discharge destination, anticipate patient discharge needs postoperatively, and reduce health care costs and morbidity associated with prolonged LOS.

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