39. Anterior cervical discectomy and fusions (ACDFs) at physician-owned hospitals: is it time to reconsider the sanctions of the Affordable Care Act (ACA)?

Abstract

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 CONCLUSIONS The results of the study suggest that elective 1- to 3-level 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.