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161 Direct Cost Analysis of 38 Cervical Spinal Deformity Operations Across Two Major Spinal Deformity Centers with Implications for Catastrophic Costs and 90-Day Cost Bundles
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161 Direct Cost Analysis of 38 Cervical Spinal Deformity Operations Across Two Major Spinal Deformity Centers with Implications for Catastrophic Costs and 90-Day Cost Bundles
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Journal Article
161 Direct Cost Analysis of 38 Cervical Spinal Deformity Operations Across Two Major Spinal Deformity Centers with Implications for Catastrophic Costs and 90-Day Cost Bundles
2017
Overview
Abstract
INTRODUCTION
CMS has recently implemented 90-day cost bundles for joint replacement surgery, and taken steps to expand bundled payment programs. Our goal is to determine the 90-day costs associated with cervical spinal deformity cases across two major spinal deformity centers in order to guide the development of reasonable bundled payment plans.
METHODS
Retrospective evaluation of adults who underwent cervical deformity surgery 2013–2016 at two major spinal deformity centers (UCSF, Baylor). Inclusion criteria included adult patients with cervical kyphosis (C2-7 Cobb angle >10°°) or cervical scoliosis (coronal Cobb able >10°). Direct hospital costs for the index surgery and all visits within the first 90 days after surgery were determined from hospital billing data. Direct costs include surgical supplies/implants, room/care, pharmacy; they exclude indirect costs like overhead, administration, and utilities.
RESULTS
>38 patients (25F, 13M; mean age = 60.4 ± 9.8 years) underwent fusions for cervical deformity. 29 procedures were posterior, 1 anterior, 7 anterior-posterior, and 1 posterior-anterior-posterior. Average number of levels fused was 9.3 ± 3.3. Average direct hospital cost for the 90-day period including surgery was $64,480 ± 23,816, and was similar between institutions ($62,569 versus $70,638). 4 of 38 patients (10.5%) were re-admitted within 90-days: re-admission costs constitute the majority of these patients' post-index surgery costs. 2 of 38 (5.3%) patients had catastrophic 90-day costs, greater than two standard deviations above the mean (>$112,112).
CONCLUSION
The average 90-day direct hospital costs for patients undergoing cervical deformity surgery are $64,480. Readmissions and a greater number of operated levels contribute to higher costs; reasonable 90-day cost bundle plans must account for both of these issues. A limitation is that our analysis includes costs at our main hospital only; it does not include post-operative outpatient medications, physical therapy, rehabilitation, or admissions to outside hospitals. It is therefore imperative that further studies utilizing national databases are performed to understand the full scope of 90-day costs.
Publisher
Oxford University Press,Copyright by the Congress of Neurological Surgeons,Wolters Kluwer Health, Inc
Subject
