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Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery.
Nunley, Pierce D; Mundis, Gregory M; Fessler, Richard G; Park, Paul; Zavatsky, Joseph M; Uribe, Juan S; Eastlack, Robert K; Chou, Dean; Wang, Michael Y; Anand, Neel; Frank, Kelly A; Stone, Marcus B; Kanter, Adam S; Shaffrey, Christopher I; Mummaneni, Praveen V.
Afiliación
  • Nunley PD; Spine Institute of Louisiana, Shreveport, Louisiana.
  • Mundis GM; San Diego Center for Spinal Disorders, San Diego, California.
  • Fessler RG; Scripps Clinic, La Jolla, California.
  • Park P; Rush University, Chicago, Illinois.
  • Zavatsky JM; University of Michigan, Ann Arbor, Michigan.
  • Uribe JS; Spine & Scoliosis Specialists, Tampa, Florida.
  • Eastlack RK; University of South Florida, Tampa, Florida.
  • Chou D; Scripps Clinic, La Jolla, California.
  • Wang MY; University of California, San Francisco, California.
  • Anand N; University of Miami, Florida.
  • Frank KA; Cedars-Sinai Medical Center, Los Angeles, California.
  • Stone MB; Spine Institute of Louisiana, Shreveport, Louisiana.
  • Kanter AS; Spine Institute of Louisiana, Shreveport, Louisiana.
  • Shaffrey CI; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and.
  • Mummaneni PV; University of Virginia Neurological Surgery, Charlottesville, Virginia.
Neurosurg Focus ; 43(6): E11, 2017 Dec.
Article en En | MEDLINE | ID: mdl-29191102
OBJECTIVE The aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery. METHODS Medicare's Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion. RESULTS Pooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay. CONCLUSIONS Reimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Anomalías Congénitas / Medicare / Grupos Diagnósticos Relacionados / Costos y Análisis de Costo / Tiempo de Internación Tipo de estudio: Diagnostic_studies / Health_economic_evaluation Límite: Adult / Humans País/Región como asunto: America do norte Idioma: En Revista: Neurosurg Focus Asunto de la revista: NEUROCIRURGIA Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Anomalías Congénitas / Medicare / Grupos Diagnósticos Relacionados / Costos y Análisis de Costo / Tiempo de Internación Tipo de estudio: Diagnostic_studies / Health_economic_evaluation Límite: Adult / Humans País/Región como asunto: America do norte Idioma: En Revista: Neurosurg Focus Asunto de la revista: NEUROCIRURGIA Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos