570 - A Multi-variate Analysis of Clinical and Financial Factors Influencing...

#570 A Multi-variate Analysis of Clinical and Financial Factors Influencing Charges and Payments for 1-3 Level Anterior Cervical Decompression and Fusions

Value and Outcomes in Spine Surgery

Poster Presented by: S. Virk

Author(s):

S. Virk (1)
F. Phillips (2)
S. Khan (1)

(1) Ohio State University, Orthopaedics, Columbus, OH, United States
(2) Rush University Medical Center, Orthopaedics, Chicago, IL, United States

Abstract

Background: The anterior cervical discectomy and fusion (ACDF) procedure has been shown to be a cost-effective procedure. To date, however, there has been no analysis of the factors influencing costs and reimbursement for this procedure.

Methods: Clinical and financial data were retrospectively reviewed for 176 patients undergoing an ACDF procedure in 2013 and 2014. Patients were included if they had a primary ACDF or revision for adjacent segment disease. We excluded those patients being treated for a traumatic cervical spine fracture, infection, front/back procedure or total disc replacement procedure. Clinical factors analyzed included the number of levels fused, surgical time, the length of stay in the hospital, estimated blood loss, implant type, Charleston Comorbidity Index (CCI), and if the surgery was being performed for adjacent segment disease (ASD). Payer type, reimbursement and charges associated with the physician and hospital fees were collected for each patient. We performed a multivariate analysis using a multiple linear regression model to determine the factors influencing charge and reimbursement data. All variables were first tested via a univariate linear regression analysis or an Analysis of Variance (ANOVA) for non-continuous variable groups. Variables were only included in the multi-variate analysis if there was a significant (p < 0.05) impact on either charges/reimbursement within the univariate analysis.

Results: From 176 patients there were 147 patients that met our inclusion criteria. The average reimbursement per patient was $23,440 (+/- 14,566) and the average charges per patient was $96,202 (+/- $32,905). The significant factors influencing charges were surgery time (p< 0.001), length of hospital stay (p < 0.001), number of levels fused (p = 0.018) and the implant type (p < 0.001). The significant factors influencing reimbursement were payer type (p < 0.001), surgery time (p = 0.036), and length of hospital stay (p < 0.001).

Conclusions: There is substantial variability in reimbursement and charges for ACDF procedures. Multivariate analysis indicates that factors such as surgery time, payer type and length of hospital stay significantly influence reimbursement. As hospital systems and payers move towards uniform bundled payments, there will need to be future research into how to control charges/reimbursement variability for patients undergoing an ACDF procedure while still maintaining high value care delivery.