Introduction: CMS has recently implemented 90-day cost bundles for joint replacement surgery, and taken steps to expand bundled payment programs. Our goal is to determine the 90-day costs associated with cervical spinal deformity cases across two major spinal deformity centers in order to guide the development of reasonable bundled payment plans.
Methods: Retrospective evaluation of adults who underwent cervical deformity surgery 2013-2016 at two major spinal deformity centers (UCSF, Baylor). Inclusion criteria included adult patients with cervical kyphosis (C2-7 Cobb angle >10°) or cervical scoliosis (coronal Cobb able >10°). Direct hospital costs for the index surgery and all visits within the first 90 days after surgery were determined from hospital billing data. Direct costs include surgical supplies/implants, room/care, pharmacy; they exclude indirect costs like overhead, administration, and utilities.
Results: 38 patients (25F, 13M; mean age=60.4±9.8 years) underwent fusions for cervical deformity. 29 procedures were posterior, 1 anterior, 7 anterior-posterior, and 1 posterior-anterior-posterior. Average number of levels fused was 9.3±3.3. Average direct hospital cost for the 90-day period including surgery was $64,480±23,816, and was similar between institutions ($62,569 versus $70,638). 4 of 38 patients (10.5%) were re-admitted within 90-days: re-admission costs constitute the majority of these patients’ post-index surgery costs. 2 of 38 (5.3%) patients had catastrophic 90-day costs, greater than two standard deviations above the mean (>$112,112).
Conclusions: The average 90-day direct hospital costs for patients undergoing cervical deformity surgery are $64,480. Readmissions and a greater number of operated levels contribute to higher costs; reasonable 90-day cost bundle plans must account for both of these issues. A limitation is that our analysis includes costs at our main hospital only; it does not include post-operative outpatient medications, physical therapy, rehabilitation, or admissions to outside hospitals. It is therefore imperative that further studies utilizing national databases are performed to understand the full scope of 90-day costs.
Patient Care: The Centers for Medicare and Medicaid Services has implemented 90-day cost bundles for joint replacement surgery, and taken steps to expand bundled payment plans. In this economic and political climate, it is essential that we understand the 90-day costs associated with spinal surgery so that we can guide the development of reasonable and appropriate 90-day cost bundles for our cases.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Discuss the average 90-day costs associated with cervical spinal deformity surgery at two major deformity centers
2) Describe the factors affecting variation in cost for these cases
3) Explain the importance of identifying catastrophic cost outliers in the formation of reasonable 90-day bundled payment programs