128. Posterior lumbar fusions (PLFs) at physician-owned hospitals: reconsidering the restrictions of the Affordable Care Act (ACA)

Abstract

BACKGROUND CONTEXT Due to perceptions and concerns about unnecessary high resource utilization/costs and low quality of care provided in physician owned hospitals, the Affordable Care Act (ACA) of 2010 imposed restrictions on existing physician-owned hospitals from expanding. PURPOSE The current study aimed to assess differences in 90-day costs and outcomes between patients undergoing elective 1-to-3 level posterior lumbar fusions (PLFs) at physician-owned hospitals vs non-physician–owned hospitals. STUDY DESIGN/SETTING Retrospective review of 2007-2014 100% Medicare Standard Analytical Files (SAF100) database. PATIENT SAMPLE The 2007-2014 Medicare 100% Standard Analytical Files (SAF100) database was queried using International Classification of Diseases, 9th Edition (ICD-9) procedure code for patients undergoing elective 1- to 3-level posterior lumbar fusions (81.07, 81.08 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 posterior lumbar fusions at these hospitals from the SAF100 database. OUTCOME MEASURES Ninety-day complications, readmissions, charges and costs. METHODS Multivariate logistic and linear regression analyses were used to assess significant differences in 90-day complications, readmissions, charges and costs between the two groups. RESULTS A total of 6,679 (2.9%) patients received an elective posterior lumbar fusion at a physician-owned hospital (N=39; 2.2%) whereas 225,090 (97.1%) received surgery at non-physician–owned hospital (N=1,774; 97.8%). After controlling for age, gender, region, hospital factors (socioeconomic status area, urban vs rural location and volume) and ECI, undergoing surgery at physician-owned hospital was associated with lower odds of thromboembolic complications (OR 0.66 [95% CI 0.53-0.82]; p CONCLUSIONS Our results suggest that patients undergoing elective 1-to-3 level PLFs at physician-owned hospitals have fewer charges and costs over the 90-day episode of care, while having lower odds of experiencing urinary tract infections, thromboembolic complications and renal complications within 90-days of the surgery. 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.