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  • Disparities in Reportable Quality Metrics by Insurance Status in the Primary Spine Neoplasm Population

    Final Number:

    Syed K Mehdi BS; 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: The incidence of adverse quality events as defined by the Centers for Medicare and Medicaid Services (CMS) among patients hospitalized for primary spinal neoplasms is unknown. Similarly, the relationship between insurance status and the incidence of adverse care quality is also unknown. We aimed to determine the incidence of patient safety indicators (PSI) among patients admitted with primary spinal neoplasms, and to determine the association between insurance status and the incidence of PSI in this population.

    Methods: The Nationwide Inpatient Sample (NIS) was queried for all hospitalizations with a diagnosis of spinal neoplasm during the inpatient episode from 1998-2011. Incidence of PSI was determined using publicly available lists of ICD-9-CM diagnosis codes. Logistic regression models were used to determine the effect of primary payer status on PSI incidence. All comparisons were made between privately insured patients and Medicaid/self-pay patients.

    Results: We identified 6,095 hospitalizations in which a spinal neoplasm was recorded during the inpatient episode. We excluded patients less than 18 years of age and with “other” or “missing” primary insurance status, leaving 5,880 patients for analysis. After adjusting for patient demographics and hospital characteristics, Medicaid/self-pay patients had significantly greater odds of experiencing one or more PSI (OR 1.81 95% CI 1.11- 2.95) relative to privately insured patients.

    Conclusions: Among patients hospitalized for primary spinal neoplasms, primary payer status predicts the incidence of PSI, an indicator of adverse healthcare quality used to determine hospital reimbursement by CMS. As reimbursement continues to be intertwined with reportable quality metrics, identifying vulnerable populations is critical to improving patient care.

    Patient Care: This study is the first to demonstrate an association between insurance status and the quality of care administered to patients undergoing inpatient treatment for primary spinal neoplasms. PSI are a quantitative tool implemented by CMS for measuring quality of care received by hospitalized patients to determine hospital reimbursement. As reimbursement continues to become intertwined with reportable patient outcomes, PSI will increasingly serve as a metric for clinicians and hospitals. Identifying methods to reduce the incidence of PSI in hospitalized patients will therefore not only benefit patients but also surgeons and hospital systems. By identifying disparities in the incidence of PSI among patients with different insurance status, our research has laid the foundation for future projects to better understand the cause of these observed disparities in PSI incidence and to develop initiatives that can improve care quality for all patient populations.

    Learning Objectives: By the conclusion of this session, participants should be able to both describe the importance of identifying disparities in the incidence of PSI among different patient populations and better understand the reasons for these disparities in order to initiate reforms that can improve care quality for all patient populations.


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