- Email: [email protected]
40. Posterior cervical fusion for fracture vs degenerative cervical spine disease: implications for a bundled payment model
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S1−S58
39. Anterior cervical discectomy and fusions (ACDFs) at physicianowned hospitals: is it time to reconsider the sanctions of the Affordable Care Act (ACA)? Azeem T. Malik, MBBS1, Frank M. Phillips, MD2, Sheldon Retchin, MD3, Wendy Xu, PhD3, Safdar N. Khan, MD1; 1 The Ohio State University Wexner Medical Center, Columbus, OH, US; 2 Midwest Orthopaedics At Rush, Chicago, IL, US; 3 Columbus, OH, US BACKGROUND CONTEXT: Due to concerns regarding higher cost and low quality of care provided in physician-owned hospitals, the Affordable Care Act (ACA) imposed sanctions that prevented the formation of new physician-owned hospitals and limited expansion of current facilities. With the demand of spine care growing across the United States, there is a need for re-evaluation and assessment of quality of spine surgical care provided at these physician-owned hospitals. PURPOSE: The current study utilizes a national Medicare dataset to assess whether elective 1- to 3-level anterior cervical discectomy and fusions (ACDFs) being performed at physician-owned hospitals are safe and cost-efficacious as compared to non-physician-owned hospitals. STUDY DESIGN/SETTING: Retrospective review of 100% Medicare Claims Database. PATIENT SAMPLE: The 2005-2014 Medicare 100% Standard Analytical Files (SAF100) was queried using International Classification of Diseases 9th Edition (ICD-9) procedure code for patients undergoing elective 1- to 3-level ACDFs (81.02 and 81.62). The Medicare Hospital Compare database was used to identify provider codes for physician-owned hospitals and were cross-referenced to identify records of patients receiving elective ACDFs at these hospitals from the SAF100 database. OUTCOME MEASURES: Ninety-day complications, readmissions, and costs. METHODS: Multivariate logistic and linear regression analyses were used to assess significant differences in 90-day complications, readmissions and costs between the two groups, while controlling for age, gender, region, hospital factors (socioeconomic status area, urban vs rural location and volume) and Elixahuser Comorbidity Index. RESULTS: After controlling for age, gender, region, hospital factors (socioeconomic status area, urban vs rural location and volume) and ECI, undergoing ACDFs at physician-owned hospital was associated with lower odds of cardiac complications (OR 0.80 [95% CI 0.73-0.86]; p<0.001), septic complications (OR 0.87 [95% CI 0.79-0.96]; p=0.007), deep venous thrombosis (OR 0.71 [95% CI 0.54-0.93]; p=0.015, renal complications (OR 0.74 [95% CI 0.64-0.86]; p<0.001) and readmissions (OR 0.83 [95% CI 0.71-0.97]; p=0.019).ACDFs being performed at physician-owned hospitals vs non-physician-owned hospitals also had lower risk-adjusted inpatient costs (-$1,517) and 90-day costs (-$1,927). No significant differences were noted between physician owned vs non-physician-owned hospitals with regard to wound complications (p=0.187), pulmonary complications (p=0.241), urinary tract infections (p=0.077), pain complications (p=0.984), dysphagia (p=0.905) and revision surgery (p=0.209). CONCLUSIONS: The results of the study suggest that elective 1- to 3level ACDFs at physician owned hospitals have significant cost-savings (over $1,900/case), while having lower odds of experiencing 90-day medical complications and readmissions. The findings call into the need for revaluation/reconsideration of the ACAs restriction on the expansion of these physician-owned hospitals. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.052
40. Posterior cervical fusion for fracture vs degenerative cervical spine disease: implications for a bundled payment model Azeem T. Malik, MBBS, Elizabeth Yu, MD, Jeffery Kim, MD, Safdar N. Khan, MD; The Ohio State University Wexner Medical Center, Columbus, OH, US
BACKGROUND CONTEXT: Current bundled payment models for cervical fusions, such as the Bundled Payments for Care Improvement (BCPI) revolve around the use of Diagnosis-Related-Groups (DRGs) to categorize patients for reimbursement purposes. Though a posterior cervical fusion (PCF) performed for a fracture may have a different postoperative course of care as compared to a fusion being done for degenerative cervical spine pathology, the current DRG system does not differentiate patients based on the indication/cause of surgery. PURPOSE: Understand differences in 30-day outcomes between patients undergoing PCF for fracture vs degenerative cervical spine disease. STUDY DESIGN/SETTING: Retrospective review of prospectively collected registry. PATIENT SAMPLE: The 2012-2017 American College of Surgeons − National Surgical Quality Improvement Program (ACS-NSQIP) was queried using Current Procedural Terminology code 22600 to identify patients receiving elective posterior cervical fusions. Patients undergoing anterior fusions, combined anterior-posterior surgery, surgery for deformity and tumors were excluded to capture an isolated cohort of patients receiving fusion for fractures or degenerative cervical pathology. OUTCOME MEASURES: Rates of 30-day adverse events, readmissions, length of stay and non-home discharge. METHODS: Multivariate analyses were used to compare rates of 30-day severe adverse events (SAE), minor adverse events (MAE), readmissions, length of stay and non-home discharges between the two groups while controlling for differences in baseline clinical characteristics. RESULTS: A total of 2,786 PCFs were included, out of which 2,546 (91.4%) were performed for degenerative cervical spine pathology and 240 (8.6%) for fracture. Following adjustment for differences in baseline clinical characteristics, patients undergoing a PCF for a fracture vs degenerative pathology had higher odds of severe adverse events (18.8% vs 10.6%, OR 1.65 [95% CI 1.10-2.46]; p=0.015), prolonged length of stay >3 days (54.2% vs 40.5%, OR 1.93 [95% CI 1.44-2.59]; p<0.001) and non-home discharges (34.2% vs 27.6%, OR 1.54 [95% CI 1.10-2.17]; p=0.012). CONCLUSIONS: Patients undergoing PCFs for fracture have significantly higher rates of postoperative adverse events and greater resource utilization as compared to individuals undergoing elective PCF for degenerative spine pathology. The study calls into question the need of risk-adjustment of bundled-prices based on indication/cause of the surgery to prevent the creation of a financial disincentive when taking care/performing surgery in spinal trauma patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.053
41. Reliability of the Neck Disability index (NDI) and Japanese Orthopedic Association (JOA) questionnaires in adult cervical radiculopathy and myelopathy patients when administered by telephone or via online format Gaurang Gupte, BS1, Jacob M. Buchowski, MD, MS2, Colleen M. Peters, MA3, Lukas P. Zebala, MD2; 1 St. Louis, MO, US; 2 Washington University School of Medicine, Saint Louis, MO, US; 3 Washington University School of Medicine, Department of Orthopedics, Saint Louis, MO, US BACKGROUND CONTEXT: The internal validity of long-term studies is significantly affected by the high loss to follow-up in the spine surgery population (>20%). Phone and email-based administration of patientreported outcomes instruments is a less cumbersome approach for increasing response rates and assessment frequency while potentially decreasing follow-up burden on patients and physicians. PURPOSE: The study sought to validate phone and email administration of the Neck Disability Index (NDI) and the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOA) in cervical myelopathy and/or radiculopathy patients.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S1−S58
39. Anterior cervical discectomy and fusions (ACDFs) at physicianowned hospitals: is it time to reconsider the sanctions of the Affordable Care Act (ACA)? Azeem T. Malik, MBBS1, Frank M. Phillips, MD2, Sheldon Retchin, MD3, Wendy Xu, PhD3, Safdar N. Khan, MD1; 1 The Ohio State University Wexner Medical Center, Columbus, OH, US; 2 Midwest Orthopaedics At Rush, Chicago, IL, US; 3 Columbus, OH, US BACKGROUND CONTEXT: Due to concerns regarding higher cost and low quality of care provided in physician-owned hospitals, the Affordable Care Act (ACA) imposed sanctions that prevented the formation of new physician-owned hospitals and limited expansion of current facilities. With the demand of spine care growing across the United States, there is a need for re-evaluation and assessment of quality of spine surgical care provided at these physician-owned hospitals. PURPOSE: The current study utilizes a national Medicare dataset to assess whether elective 1- to 3-level anterior cervical discectomy and fusions (ACDFs) being performed at physician-owned hospitals are safe and cost-efficacious as compared to non-physician-owned hospitals. STUDY DESIGN/SETTING: Retrospective review of 100% Medicare Claims Database. PATIENT SAMPLE: The 2005-2014 Medicare 100% Standard Analytical Files (SAF100) was queried using International Classification of Diseases 9th Edition (ICD-9) procedure code for patients undergoing elective 1- to 3-level ACDFs (81.02 and 81.62). The Medicare Hospital Compare database was used to identify provider codes for physician-owned hospitals and were cross-referenced to identify records of patients receiving elective ACDFs at these hospitals from the SAF100 database. OUTCOME MEASURES: Ninety-day complications, readmissions, and costs. METHODS: Multivariate logistic and linear regression analyses were used to assess significant differences in 90-day complications, readmissions and costs between the two groups, while controlling for age, gender, region, hospital factors (socioeconomic status area, urban vs rural location and volume) and Elixahuser Comorbidity Index. RESULTS: After controlling for age, gender, region, hospital factors (socioeconomic status area, urban vs rural location and volume) and ECI, undergoing ACDFs at physician-owned hospital was associated with lower odds of cardiac complications (OR 0.80 [95% CI 0.73-0.86]; p<0.001), septic complications (OR 0.87 [95% CI 0.79-0.96]; p=0.007), deep venous thrombosis (OR 0.71 [95% CI 0.54-0.93]; p=0.015, renal complications (OR 0.74 [95% CI 0.64-0.86]; p<0.001) and readmissions (OR 0.83 [95% CI 0.71-0.97]; p=0.019).ACDFs being performed at physician-owned hospitals vs non-physician-owned hospitals also had lower risk-adjusted inpatient costs (-$1,517) and 90-day costs (-$1,927). No significant differences were noted between physician owned vs non-physician-owned hospitals with regard to wound complications (p=0.187), pulmonary complications (p=0.241), urinary tract infections (p=0.077), pain complications (p=0.984), dysphagia (p=0.905) and revision surgery (p=0.209). CONCLUSIONS: The results of the study suggest that elective 1- to 3level ACDFs at physician owned hospitals have significant cost-savings (over $1,900/case), while having lower odds of experiencing 90-day medical complications and readmissions. The findings call into the need for revaluation/reconsideration of the ACAs restriction on the expansion of these physician-owned hospitals. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.052
40. Posterior cervical fusion for fracture vs degenerative cervical spine disease: implications for a bundled payment model Azeem T. Malik, MBBS, Elizabeth Yu, MD, Jeffery Kim, MD, Safdar N. Khan, MD; The Ohio State University Wexner Medical Center, Columbus, OH, US
BACKGROUND CONTEXT: Current bundled payment models for cervical fusions, such as the Bundled Payments for Care Improvement (BCPI) revolve around the use of Diagnosis-Related-Groups (DRGs) to categorize patients for reimbursement purposes. Though a posterior cervical fusion (PCF) performed for a fracture may have a different postoperative course of care as compared to a fusion being done for degenerative cervical spine pathology, the current DRG system does not differentiate patients based on the indication/cause of surgery. PURPOSE: Understand differences in 30-day outcomes between patients undergoing PCF for fracture vs degenerative cervical spine disease. STUDY DESIGN/SETTING: Retrospective review of prospectively collected registry. PATIENT SAMPLE: The 2012-2017 American College of Surgeons − National Surgical Quality Improvement Program (ACS-NSQIP) was queried using Current Procedural Terminology code 22600 to identify patients receiving elective posterior cervical fusions. Patients undergoing anterior fusions, combined anterior-posterior surgery, surgery for deformity and tumors were excluded to capture an isolated cohort of patients receiving fusion for fractures or degenerative cervical pathology. OUTCOME MEASURES: Rates of 30-day adverse events, readmissions, length of stay and non-home discharge. METHODS: Multivariate analyses were used to compare rates of 30-day severe adverse events (SAE), minor adverse events (MAE), readmissions, length of stay and non-home discharges between the two groups while controlling for differences in baseline clinical characteristics. RESULTS: A total of 2,786 PCFs were included, out of which 2,546 (91.4%) were performed for degenerative cervical spine pathology and 240 (8.6%) for fracture. Following adjustment for differences in baseline clinical characteristics, patients undergoing a PCF for a fracture vs degenerative pathology had higher odds of severe adverse events (18.8% vs 10.6%, OR 1.65 [95% CI 1.10-2.46]; p=0.015), prolonged length of stay >3 days (54.2% vs 40.5%, OR 1.93 [95% CI 1.44-2.59]; p<0.001) and non-home discharges (34.2% vs 27.6%, OR 1.54 [95% CI 1.10-2.17]; p=0.012). CONCLUSIONS: Patients undergoing PCFs for fracture have significantly higher rates of postoperative adverse events and greater resource utilization as compared to individuals undergoing elective PCF for degenerative spine pathology. The study calls into question the need of risk-adjustment of bundled-prices based on indication/cause of the surgery to prevent the creation of a financial disincentive when taking care/performing surgery in spinal trauma patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.053
41. Reliability of the Neck Disability index (NDI) and Japanese Orthopedic Association (JOA) questionnaires in adult cervical radiculopathy and myelopathy patients when administered by telephone or via online format Gaurang Gupte, BS1, Jacob M. Buchowski, MD, MS2, Colleen M. Peters, MA3, Lukas P. Zebala, MD2; 1 St. Louis, MO, US; 2 Washington University School of Medicine, Saint Louis, MO, US; 3 Washington University School of Medicine, Department of Orthopedics, Saint Louis, MO, US BACKGROUND CONTEXT: The internal validity of long-term studies is significantly affected by the high loss to follow-up in the spine surgery population (>20%). Phone and email-based administration of patientreported outcomes instruments is a less cumbersome approach for increasing response rates and assessment frequency while potentially decreasing follow-up burden on patients and physicians. PURPOSE: The study sought to validate phone and email administration of the Neck Disability Index (NDI) and the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOA) in cervical myelopathy and/or radiculopathy patients.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.