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  • Insurance Status Predicts Patient Safety and Care Quality in the Lumbar Spine Fusion Population

    Final Number:

    Joseph E Tanenbaum BA; Vincent J Alentado MD; Jacob A. Miller BS; Daniel Lubelski MD; Edward C. Benzel MD; Thomas E. Mroz MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Lumbar fusion is a common and costly procedure in the United States. Reimbursement for surgical procedures is increasingly tied to care quality and patient safety as part of value-based reimbursement programs. The incidence of adverse quality events among lumbar fusion patients is unknown using the definition of care quality (named patient safety indicators [PSI]) utilized by the Centers for Medicare and Medicaid Services (CMS). Disparities in PSI incidence have been observed across insurance groups in other surgical spine populations. The association between insurance status and the incidence of adverse care quality as measured by PSI unknown in lumbar fusion patients

    Methods: Nationwide inpatient sample (NIS) data were queried for all cases of inpatient lumbar fusion from 1998-2011.Patients were excluded if “other” or “missing” was listed for primary insurance status and if age was less than eighteen years. Incidence of adverse patient safety events (PSI) was determined using publicly available lists of ICD-9-CM diagnosis codes. Logistic regression models were used to determine the association between primary payer status (Medicaid/self-pay relative to private insurance) and the incidence of PSI.

    Results: From 1998-2011, 564,930 lumbar fusion procedures were recorded in the NIS. After applying inclusion criteria, 461,417 remained for analysis. The national incidence of PSI was calculated to be 2,445 per 100,000 patient years of observation, or approximately 2.5% After adjusting for patient demographics and hospital characteristics, Medicaid/self-pay patients had significantly greater odds of experiencing one or more PSI during the inpatient episode relative to privately insured patients (OR 1.16 95% CI 1.07 – 1.27).

    Conclusions: Among patients undergoing inpatient lumbar fusion, insurance status predicts adverse healthcare quality events used to determine hospital reimbursement by CMS. The source of this disparity must be studied to improve the quality of care delivered to vulnerable patient populations.

    Patient Care: This study highlights disparities in patient safety and care quality across insurance groups among patients undergoing lumbar fusion. As the U.S. healthcare system continues to transition to a value-based reimbursement model, measures such as PSI will be increasingly used to determine care quality and value. The results of the present study can be used to support initiatives designed to eliminate disparities by improving the quality of care delivered to vulnerable patient populations.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe how patient safety indicators are used by CMS to measure care quality and determine reimbursement and how these measures can be applied to surgical spine care, 2) Identify disparities in quality of care in the lumbar spine fusion population across insurance and socioeconomic groups, 3) Identify the benefits to patients, physicians, and hospital systems inherent in eliminating disparities in quality of care for lumbar spinal fusion patients.


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