hospital characteristics Richard L. Skolasky, ScD Department of - - PowerPoint PPT Presentation

Medicare charges and payments for cervical spine surgery: Influence of hospital characteristics

Richard L. Skolasky, ScD

Department of Orthopaedic Surgery, Associate Professor Spine Outcomes Research Center, Director

Medicare charges and payments for cervical spine surgery: Influence of hospital characteristics

Skolasky RL and Riley LH III

Background

• Previous research has demonstrated the

importance of geographic variation on hospital charges1,2

• The influence of other characteristics is not

well understood

Background

• March 2013, CMS Physician Payment

“Sunshine” Final Rule3

• PPACA mandated increased transparency in

health care costs and charges

• CMMS released 2011 Inpatient Prospective

Payment System data

Objective

• To determine the influence of hospital

characteristics on the average covered charge and total payments for Medicare patients undergoing cervical spine fusion

Methods

• Medicare Inpatient Prospective Payment

System (IPPS)

• Extract hospital level data cervical spine fusion

(without complication or major complication, DRG 473)

• Average covered charge: hospital charge for

items and services

• Total payment: Medicare reimbursement

Methods

• Nationwide Inpatient Sample (NIS)
• Extract hospital discharge data (DRG 473)
• Hospital characteristics: bed size; ownership;

location; teaching status; geographic region

Methods

• Identified unique hospitals and matched on

unique hospital identifiers

• Estimate relationship between cost and

hospital characteristics

• Univariate
• Multivariate

Results

• Cost data
• Average covered charge

$65,574 (SD $28,858)

• Average Total payment

$15,199 (SD $3,277)

Results

Characteristic Percent Average covered charge Total payment Bed size Small 9.7% $60,516 ($17,177) $14,902 ($2,610) Medium 31.6% $58,134 ($20,590) $13,808 ($1,858) Large 58.7% $69,837 ($32,765) $15,899 ($3,684) Ownership Gov’t or private 49.1% $67,276 ($32,944) $16,206 ($3,791) Gov’t, non federal 7.0% $59,784 ($4,465) $13,806 ($4,204) Private, not for profit 26.3% $65,521 ($27,138) $14,654 ($2,315) Private, investor-owned 14.9% $69,094 ($19,654) $13,653 ($1,951) Private 2.6% $40,092 ($19,481) $13,592 ($2,468)

Results

Characteristic Percent Average covered charge Total payment Location Rural 5.3% $48,689 ($18,112) $14,082 ($2,119) Urban 94.5% $67,955 ($29,372) $15,356 ($3,390) Teaching Non-teaching 59.6% $63,380 ($22,820) $14,599 ($2,429) Teaching 40.4% $69,680 ($37,772) $16,320 ($4,278) Region Northeast 7.9% $55,921 ($18,348) $15,324 ($1,748) Midwest 20.2% $73,474 ($40,454) $17,130 ($4,074) South 32.5% $62,066 ($19,281) $13,616 ($2,499) West 39.5% $64,956 ($27,819) $15,276 ($2,769)

Results

• $30,000
• $20,000
• $10,000

$0 $10,000 $20,000 $30,000 Average Total Charge Average Total Payment

Conclusions

• Hospital characteristics have significant

influence on total charges

• The influence of these characteristics on

total reimbursement is moderated

Conclusions

• Variation by geography, urban, and

teaching may reflect differential implementation of new technologies4

• Reasons for variation by size and ownership

are not clear

References

1.

Alosh H, Riley LH 3rd, Skolasky RL. Health care burden of anterior cervical spine surgery: National trends in hospital charges and length of stay, 2000 to 2009.

2.

Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES. United States’ trends and regional variation in lumbar spine surgery: 1992-2003.

3.

“CMS Physician Payment ‘Sunshine’ Final Rule – Overview and Analysis” Health Industry Washington Watch, http://www.healthindustrywashingtonwatch.com/2013/03/articles/regulatory- developments/cms-physician-payment-sunshine-final-rule-overview-and-analysis/. December 4, 2013.

4.

Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES. United states' trends and regional variations in lumbar spine surgery: 1992-2003. Spine. 2006;31:2707-2714.

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