1
|
Durand WM, Musharbash FN, Ortiz-Babilonia CD, Jain A. Characteristics of Spine Surgery Performed at Ambulatory Surgical Centers. Spine (Phila Pa 1976) 2023; 48:143-145. [PMID: 36122294 DOI: 10.1097/brs.0000000000004480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/19/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Wesley M Durand
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Farah N Musharbash
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Carlos D Ortiz-Babilonia
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
- Department of Orthopaedic Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
2
|
Hussain I, Hofstetter CP, Wang MY. Innovations in Spinal Endoscopy. World Neurosurg 2022; 160:138-148. [PMID: 35364672 DOI: 10.1016/j.wneu.2021.11.099] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 10/18/2022]
Abstract
Innovations in spinal endoscopy technology and technique have broadened their applications during the past 10 years. Smaller outer-diameter working-channel endoscopes have permitted safe usage in the cervical spine for full endoscopic decompressions. Endoscopic fusions have now been widely reported, leveraging compatible instrumentation for disc preparation and expandable interbody grafts. This ultra-minimally invasive technique has also enabled the performance of fusion procedures in awake patients under monitored anesthesia care, affording speedier recovery and treatment options for those unable to undergo general anesthesia. Revision surgery after open or minimally invasive posterior discectomy or instrumentation can now be performed with endoscopic techniques, which often leverage the transforaminal approach to avoid scar tissue and adhesions. These procedures, among other endoscopic surgeries, are now being increasingly performed in ambulatory surgery centers, as safe outcomes, economic benefits to the healthcare system, and patients' desire to recover at home are becoming more apparent. Finally, the standardization of endoscopic terminology, which has long been a confounder to proper communication and education in this field, has recently been addressed by leading experts in a consensus document, which will serve as the foundation for future collaborative advancements.
Collapse
Affiliation(s)
- Ibrahim Hussain
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
| | | | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| |
Collapse
|
3
|
Goacher E, Sanders MI, Ivanov M. Safety and feasibility of same-day discharge following lumbar decompression surgery: A systematic review. BRAIN AND SPINE 2022; 2:100888. [PMID: 36248095 PMCID: PMC9559968 DOI: 10.1016/j.bas.2022.100888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
|
4
|
Lopez CD, Boddapati V, Schweppe EA, Levine WN, Lehman RA, Lenke LG. Recent Trends in Medicare Utilization and Reimbursement for Orthopaedic Procedures Performed at Ambulatory Surgery Centers. J Bone Joint Surg Am 2021; 103:1383-1391. [PMID: 33780398 DOI: 10.2106/jbjs.20.01105] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As part of a market-driven response to the increasing costs of hospital-based surgical care, an increasing volume of orthopaedic procedures are being performed in ambulatory surgery centers (ASCs). The purpose of the present study was to identify recent trends in orthopaedic ASC procedure volume, utilization, and reimbursements in the Medicare system between 2012 and 2017. METHODS This cross-sectional, national study tracked annual Medicare claims and payments and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates, and reimbursement rates, and to identify demographic predictors of ASC utilization. RESULTS A total of 1,914,905 orthopaedic procedures were performed at ASCs in the Medicare population between 2012 and 2017, with an 8.8% increase in annual procedure volume and a 10.5% increase in average reimbursements per case. ASC orthopaedic procedure utilization, including utilization across all subspecialties, is strongly associated with metropolitan areas compared with rural areas. In addition, orthopaedic procedure utilization, including for sports and hand procedures, was found to be significantly higher in wealthier counties (measured by average household income) and in counties located in the South. CONCLUSIONS This study demonstrated increasing orthopaedic ASC procedure volume in recent years, driven by increases in hand procedure volume. Medicare reimbursements per case have steadily risen and outpaced the rate of inflation over the study period. However, as orthopaedic practice overhead continues to increase, other Medicare expenditures such as hospital payments and operational and implant costs also must be evaluated. These findings may provide a source of information that can be used by orthopaedic surgeons, policy makers, investors, and other stakeholders to make informed decisions regarding the costs and benefits of the use of ASCs for orthopaedic procedures.
Collapse
Affiliation(s)
- Cesar D Lopez
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | | | | | | | | | | |
Collapse
|
5
|
Lopez CD, Boddapati V, Lombardi JM, Lee NJ, Saifi C, Dyrszka MD, Sardar ZM, Lenke LG, Lehman RA. Recent trends in medicare utilization and reimbursement for lumbar spine fusion and discectomy procedures. Spine J 2020; 20:1586-1594. [PMID: 32534133 DOI: 10.1016/j.spinee.2020.05.558] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Understanding the scope of the volume and costs of lumbar fusions and discectomy procedures, as well as identifying significant trends within the Medicare system, may be beneficial in enhancing cost-efficiency and care delivery. However, there is a paucity of studies which analyze recent trends in lumbar fusion volume, utilization, and reimbursements. PURPOSE This study seeks to define the costs of lumbar fusions and discectomy procedures and identify trends and variations in volume, utilization, and surgeon and hospital reimbursement rates in the Medicare system between 2012 and 2017. STUDY DESIGN Retrospective database study. PATIENT SAMPLE Medicare Part A and Part B claims submitted for lumbar spine procedures from 2012 to 2017, as documented in the Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use Files. OUTCOME MEASURES Procedure numbers and payments per episode. METHODS This cross-sectional study tracked annual Medicare claims and payments to spine surgeons using publicly-available databases and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates (per 10,000 Medicare beneficiaries), and reimbursement rates, and to examine associations between county-specific and lumbar spine procedure utilization and reimbursements. RESULTS A total of 772,532 lumbar spine procedures were performed in the Medicare population from 2012 to 2017, including 634,335 lumbar fusion surgeries and 138,197 primary lumbar discectomy and microdiscectomy single-level surgeries. There was a 26.0% increase in annual lumbar fusion procedure volume during the study period, with a compound annual growth rate (CAGR) of 4.7%. Lumbar discectomy/microdiscectomy experienced a 23.5% decrease in annual procedure volume (CAGR, -5.2%). Mean Medicare surgeon reimbursements for lumbar fusions nominally decreased by 3.7% from $767 in 2012 to $738 in 2017, equivalent to an inflation-adjusted decrease of 11.4% (CAGR, -0.7%). Mean Medicare payments for lumbar discectomy and microdiscectomy procedures nominally increased by 16.3% from $517 in 2012 to $601 in 2017, equivalent to an inflation-adjusted increase of 6.9% (CAGR, 3.1%). CONCLUSIONS This present study found the volume and utilization of lumbar fusions have increased since 2012, while lumbar discectomy and microdiscectomy volume and utilization have fallen. Medicare payments to hospitals and surgeons for lumbar fusions have either declined or not kept pace with inflation, and reimbursements for lumbar discectomy and microdiscectomy to hospitals have risen at a disproportionate rate compared to surgeon payments. These trends in Medicare payments, especially seen in decreasing allocation of reimbursements for surgeons, may be the effect of value-based cost reduction measures, especially for high-cost orthopedic and spine surgeries.
Collapse
Affiliation(s)
- Cesar D Lopez
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Venkat Boddapati
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA.
| | - Joseph M Lombardi
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Nathan J Lee
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Comron Saifi
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Marc D Dyrszka
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Zeeshan M Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Lawrence G Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Ronald A Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| |
Collapse
|
6
|
Makanji HS, Bilolikar VK, Goyal DKC, Kurd MF. Ambulatory surgery center payment models: current trends and future directions. JOURNAL OF SPINE SURGERY 2019; 5:S191-S194. [PMID: 31656874 DOI: 10.21037/jss.2019.08.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Heeren S Makanji
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vivek K Bilolikar
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dhruv K C Goyal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
7
|
DelSole EM, Makanji HS, Kurd MF. Current trends in ambulatory spine surgery: a systematic review. JOURNAL OF SPINE SURGERY 2019; 5:S124-S132. [PMID: 31656865 DOI: 10.21037/jss.2019.04.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Spine surgery continues to move into the ambulatory setting in an effort to pair high-quality care delivery with low-cost facilities. The purpose of this review was to assess the current literature for trends in the practice of ambulatory spine surgery. A systematic review of the English language literature from the past five years was performed utilizing PRISMA standards. The results demonstrate that current focus of research emphasizes the safety of ambulatory surgery-with several studies commenting on complication rates, patient selection, and postoperative protocols to prevent readmissions or complications. Research is also focused on quality of care, and ensuring non-inferiority of ambulatory surgery when compared with traditional inpatient hospitalizations. Importantly, no level I or II literature has been published on the topic in the past five years, suggesting a renewed need for high quality prospective studies.
Collapse
Affiliation(s)
- Edward M DelSole
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Heeren S Makanji
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mark F Kurd
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| |
Collapse
|
8
|
Safety and Efficacy of Revision Minimally Invasive Lumbar Decompression in the Ambulatory Setting. Spine (Phila Pa 1976) 2019; 44:E494-E499. [PMID: 30234800 DOI: 10.1097/brs.0000000000002881] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis. OBJECTIVE The aim of this study was to investigate differences in perioperative outcomes between patients undergoing revision minimally invasive lumbar spine decompression (MIS LD) in the ambulatory and hospital-based surgical settings. SUMMARY OF BACKGROUND DATA Revision LD has been associated with an increased risk of complications compared with primary LD. Furthermore, ambulatory primary LD has been demonstrated to be a safe and viable option in appropriately selected patients. However, there is a paucity of information comparing hospital-based versus ambulatory outcomes in revision LD. METHODS A prospectively maintained surgical registry of patients undergoing revision MIS lumbar laminectomy and/or discectomy for degenerative pathology from 2013 to 2017 was retrospectively reviewed. Propensity score matching was performed to adjust for measured confounding variables, including patient age, comorbidity burden as measured by Charlson Comorbidity Index, and preoperative diagnosis. Differences in operative variables, complication rates, pain scores, narcotics consumption, and reoperation rates were assessed using Pearson Chi-squared analysis (categorical) and Student t test (continuous). RESULTS Seventy patients were included, of whom 35 underwent revision MIS LD at a hospital-based center (HBC), and 35 underwent surgery at an ambulatory surgical center (ASC). HBC and ASC patients demonstrated similar postoperative visual analog scale pain scores and hourly narcotics consumption during surgical stay (P < 0.001). ASC patients exhibited a significantly shorter length of stay than hospital-based patients (2.7 vs. 11.6 hours, P < 0.001). CONCLUSION Patients undergoing revision MIS LD in an ASC demonstrated similar perioperative outcomes as compared to patients undergoing revision MIS LD in a HBC. These results suggest that revision MIS LD can be performed safe and effectively in the ambulatory setting in an appropriately selected surgical population. Further study of patient outcomes following spine surgery performed outside of the traditional hospital setting is crucial, as the delivery of care in the ambulatory setting continues to grow in popularity. LEVEL OF EVIDENCE 3.
Collapse
|
9
|
Gornet MF, Buttermann GR, Wohns R, Billinghurst J, Brett DC, Kube R, Rafe Sales J, Wills NJ, Sherban R, Schranck FW, Copay AG. Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers vs. Hospital Settings. Int J Spine Surg 2018; 12:557-564. [PMID: 30364904 DOI: 10.14444/5068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Outpatient surgery has been shown safe and effective for anterior cervical discectomy and fusion (ACDF), and more recently, for 1-level cervical disc arthroplasty (CDA). The purpose of this analysis is to compare the safety and efficiency of 1-level and 2-level CDA performed in an ambulatory surgery center (ASC) and in a hospital setting. Methods The study was a retrospective collection and analysis of data from consecutive CDA patients treated in ASCs compared to a historical control group of patients treated in hospital settings who were classified as outpatient (0 or 1-night stay) or inpatient (2 or more nights). Surgery time, blood loss, return to work, adverse events (AEs), and subsequent surgeries were compared. Results The sample consisted of 145 ASC patients, 348 hospital outpatients, and 65 hospital inpatients. A greater proportion of 2-level surgeries were performed in hospital than ASC. Surgery times were significantly shorter in ASCs than outpatient or inpatient 1-level (63.6 ± 21.6, 86.5 ± 35.8, and 116.7 ± 48.4 minutes, respectively) and 2-level (92.4 ± 37.3, 126.7 ± 43.8, and 140.3 ± 54.5 minutes, respectively) surgeries. Estimated blood loss was also significantly less in ASC than outpatient and inpatient 1-level (18.5 ± 30.6, 43.7 ± 35.9, and 85.7 ± 98.0 mL, respectively) and 2-level (21.1 ± 12.3, 67.8 ± 94.9, and 64.9 ± 66.1 mL). There were no hospital admissions and no subsequent surgeries among ASC patients. ASC patients had 1 AE (0.7%) and hospital patients had 10 AEs (2.4%). Working patients returned to work after a similar number of days off, but fewer ASC patients had returned to work by the end of the 90-day period. Conclusions Both 1- and 2-level CDA may be performed safely in an ASC. Surgeries in ASCs are of shorter duration and performed with less blood loss without increased AEs.
Collapse
Affiliation(s)
| | | | | | | | | | - Richard Kube
- Prairie Spine and Pain Institute, Peoria, Illinois
| | - J Rafe Sales
- Northwest Spine & Laser Center, LLC, Portland, Oregon
| | | | | | | | | |
Collapse
|
10
|
Surgeon Reimbursement Relative to Hospital Payments for Spinal Fusion: Trends From 10-year Medicare Analysis. Spine (Phila Pa 1976) 2018; 43:720-731. [PMID: 28885293 DOI: 10.1097/brs.0000000000002405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, economic analysis. OBJECTIVE The aim of this study was to analyze the trend in hospital charge and payment adjusted to corresponding surgeon charge and payment for cervical and lumbar fusions in a Medicare sample population from 2005 to 2014. SUMMARY OF BACKGROUND DATA Previous studies have reported trends and variation in hospital charges and payments for spinal fusion, but none have incorporated surgeon data in analysis. Knowledge of the fiscal relationship between hospitals and surgeons over time will be important for stakeholders as we move toward bundled payments. METHODS A 5% Medicare sample was used to capture hospital and surgeon charges and payments related to cervical and lumbar fusion for degenerative disease between 2005 and 2014. We defined hospital charge multiplier (CM) as the ratio of hospital/surgeon charge. Similarly, the hospital/surgeon payment ratio was defined as hospital payment multiplier (PM). The year-wise and regional trend in patient profile, length of stay, discharge disposition, CM, and PM were studied for all fusion approaches separately. RESULTS A total of 40,965 patients, stratified as 15,854 cervical and 25,111 lumbar fusions, were included. The hospital had successively higher charges and payments relative to the surgeon from 2005 to 2014 for all fusions with an inverse relation to hospital length of stay. Increasing complexity of fusion such as for anterior-posterior cervical fusion had higher hospital reimbursements per dollar earned by the surgeon. There was regional variation in how much the hospital charged and received per surgeon dollar. CONCLUSION Hospital charge and payment relative to surgeon had an increasing trend despite a decreasing length of stay for all fusions. Although the hospital can receive higher payments for higher-risk patients, this risk is not reflected proportionally in surgeon payments. The shift toward value-based care with shared responsibility for outcomes and cost will likely rely on better aligning incentives between hospital and providers. LEVEL OF EVIDENCE 3.
Collapse
|
11
|
Yen D, Albargi A. Results and limitations of outpatient and overnight stay laminectomies for lumbar spinal stenosis. Can J Surg 2017; 60:329-334. [PMID: 28742014 DOI: 10.1503/cjs.002017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND At our centre, laminectomies have been traditionally performed as inpatient surgery. A gradual change in practice occurred between 2010 and 2013 to try to do these procedures as outpatient or overnight stay surgery. METHODS We conducted a retrospective cohort study of consecutive patients having laminectomies over 2 18-month periods: before the change in practice and after full implementation of the outpatient/overnight stay protocol. We collected information on patient characteristics (age, sex, American Society of Anesthesiologists [ASA] classification, home address, number of laminectomy levels, estimated blood loss) and patient outcome (complications, hospital length of stay, 30-day readmissions). RESULTS We found no significant difference in age, sex, ASA classification, number of laminectomy levels, or estimated blood loss between the 2 cohorts. There was a change in the number of outpatient (from 0 to 25) and overnight stay laminectomies (from 0 to 13). There was an increase in total (inpatient, overnight stay and outpatient) laminectomies from 41 to 82, and an increase in patients from out of our region from 15% to 32%. There was 1 readmission within 30 days that occurred in the first cohort. CONCLUSION We found that outpatient and overnight stay laminectomies can be done safely, with no patients requiring postoperative admission to hospital or readmissions within 30 days. They can be done in patients from out of town who need to travel home postoperatively. It is possible to safely reduce the level of resources used for spine surgery by carrying out laminectomies as outpatient or overnight stay surgery in select patients.
Collapse
Affiliation(s)
- David Yen
- From the Department of Surgery, Queen's University, Kingston, Ont
| | - Abdu Albargi
- From the Department of Surgery, Queen's University, Kingston, Ont
| |
Collapse
|
12
|
Abstract
The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process.
Collapse
|