The Impact of Quality and Patient Safety Performance on the Variable Costs of Spinal Fusion Procedures

Powered by the world’s largest real-world evidence base on patient safety and healthcare quality, the Quantros Value-based Care Factoid Series provides informative indicators and measures of clinical and financial performance that matter in value-based reimbursement and payment models.

 

Delivered in partnership with Becker’s Hospital Review, we are confident these research insights and greater transparency will help all stakeholders to accurately measure and benchmark progress on the journey to value-based, higher-quality and safer care. To read the rest of the series of factoids, click here.

The Impact of Quality and Patient Safety Performance on the Variable Costs of Spinal Fusion Procedures

Each year, more than 400,000 people choose various types of spinal fusion procedures to improve stability, correct a deformity or reduce pain, with the most common procedure being lumbar fusion. Spinal fusion is generally a safe procedure, although carries the potential risk of complications including infection, poor wound healing, bleeding, blood clots, injury to blood vessels or nerves in and around the spine, and pain at the site from which the bone graft is taken.

Spinal-fusion surgery is one of the most lucrative areas of medicine for hospitals, although its benefits and costs are increasingly scrutinized by public and private payers aiming to control in the variable costs of patient care in value-based payment and reimbursement models, such as material expenses, length of hospital stay, and rehabilitation. Reimbursement for spinal fusion procedures is increasingly tied to care quality and patient safety as part of value-based reimbursement programs.

Recent analysis of Medicare data over a recent 10-year period shows that the incidence of spinal fusion has increased at a higher rate than total joint arthroplasty, and that that hospital charges for this procedure experienced a 3.3-fold increase compared with 2.3-fold increases in charges associated with joint replacement, resulting in a $33.9 billion national expense in 2008¹.

To further assess the impact of quality and patient safety performance on the variable costs of spinal fusion procedures, Quantros analyzed the difference in excess charges, excess cost and excess days of care for hospitals ranked #1 in their respective state for medical excellence in spinal fusion (DRG 453, 454, 455, 456, 457, 458, 459, 460, 471, 472, 473), and then compared these with those hospitals ranked lowest in the state using the 2018 CareChex National Quality Ratings Database (NQRD). All of the associated excess charge, cost and length of stay assumptions rely upon Quantros’ proprietary risk adjustment model which accounts for differences in patient risk factors using select AHRQ Patient Safety Indicators (PSI-2, PSI-3, PSI-6, PSI-7, PSI-8, PSI-9, PSI-10, PSI-11, PSI-12, PSI-13, PSI-14, and PSI-15). The NQRD comprises ten (10) quarters of Medicare Fee for Service (FFS) claims data (January 2014 to June 2016) and includes virtually all general, acute, non-federal U.S. hospitals (+/- 4,500).

Quantros’ analysis reflects that in the aggregate across all U.S. States, for the Spinal Fusion procedures examined, lowest performing hospitals had nearly four times the amount of excess charges and costs, and over three times the amount of excess days of care as compared to the aggregate national cohort of top ranked hospitals:

 

 

 

____________________________________