P137. A five-year review of hospital costs and reimbursement in the surgical management of degenerative spondylolisthesis

Abstract

BACKGROUND CONTEXT Surgical management of degenerative spondylolisthesis (DS) with spinal stenosis (SS) remains controversial, as studies reveal that fusion technique may not affect outcomes. Various considerations may drive the decision to which type of fusion to use, including patient, surgeon and economic factors. PURPOSE This study was designed to characterize different charges, expenses, reimbursement, and hospital margins with non instrumented fusion in situ (PLF), posterolateral fusion with pedicle screws (PPS), and PPS with interbody device (PLIF). STUDY DESIGN/SETTING Retrospective chart review with corresponding financial audit. PATIENT SAMPLE All patients undergoing single level fusions from 2009-2014 based on ICD-9 diagnoses of DS and spinal stenosis. Multilevel fusions were excluded. OUTCOME MEASURES Primary outcome measures included all service and procedural charges (what was billed to insurance), expenses (direct costs incurred by the hospital), reimbursement, and margins that were obtained through the financial audit for each surgery and hospital stay. Overall reimbursement and margins were then calculated based on this data. METHODS A retrospective chart review was performed from 2010-2014 based on ICD-9 diagnoses of DS with SS in patients undergoing single level fusions. All service and procedural charges, expenses, hospital reimbursement, and hospital margins were obtained through the financial audit for each surgery and hospital stay. A multivariate linear regression model was used to compare patient demographics, charges, expenses, etc. A one-way analysis of variance (ANOVA) with Tukey post hoc analysis was used to analyze different reimbursements and margins based upon insurance types. RESULTS A total of 233 patients met inclusion criteria for the study. There were no significant differences with BMI, ASA class, length of stay or gender distribution. Both types of instrumented fusions had longer operating room times and estimated blood loss (P CONCLUSIONS As more instrumentation is used, the more it costs both the hospital (expenses) and the insurance company (charges). Hospital margins varied depending on both fusion method and insurance type. While charges, expenses and reimbursement tend to increase with instrumentation, hospital margins did not correspondingly. This study highlights the importance in better aligning the economic interests of all parties involved (patient, surgeon, hospital, insurance, etc.) in order to help control spending and transition to a more cost effective system. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.