P84. Predicting ASD surgeries that exceed Medicare allowable payment thresholds: a comparison of hospital costs to what the government will actually pay

Abstract

BACKGROUND CONTEXT Adult Spinal Deformity (ASD) surgery is associated with a high cost. Previous studies have suggested that the actual direct hospital cost of ASD surgery is higher than the Medicare Allowable (MA) rate. MA rates are becoming the benchmark reimbursement target for hospital accounting systems. It is important to determine what factors can predict which ASD patients have actual costs below Medicare reimbursement. PURPOSE Our goal is to (1) determine if we can develop a model to predict when index episode of care (iEOC) surgical costs of ASD surgeries are below the MA threshold and (2) to identify potentially modifiable variables. STUDY DESIGN/SETTING Retrospective analysis of a prospective multi-center ASD database. PATIENT SAMPLE Adult spinal deformity patients undergoing surgical correction enrolled into a prospective, multicenter surgical database from 2008-2014. OUTCOME MEASURES Primary outcome measure is iEOC costs and patient and hospital-specific MA reimbursements, but other baseline HRQOL outcome measures were collected such as Oswestry Disability Index (ODI), SF-36 PCS, and SF-36 MCS. METHODS From a prospective, multicenter ASD surgical database, patients undergoing long instrumented fusions (>4 level) with cost data were identified. Index episode of care (iEOC) cost was calculated by utilizing actual direct hospital cost. MA rates were calculated using the year-appropriate CMS Inpatient Pricer Payment System Tool and were hospital specific. Demographic, baseline HRQOL, radiographic and surgical variables were analyzed. A predictive model was developed to identify variables that can predict iEOC RESULTS Administrative direct cost data was obtained from 4 of 11 centers with a total of 195 patients included in the model. A total of 109 (55%) patients had iEOC below the MA threshold. There was significant variation across the 4 centers in both the mean iEOC cost ($56,788 to $78,878,p CONCLUSIONS There is significant institutional variation in ASD cost and reimbursement with an increased likelihood of 56.8% getting reimbursed more than the cost of surgery (iEOC FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.