Introduction: Patient out-of-pocket (OOP) spending is an increasingly discussed topic in our evolving healthcare environment; however, there is minimal data available on the patient financial burden of neurosurgical procedures. We sought to analyze hospital and surgeon payment data for neurosurgical patients from a comprehensive payer and case mix.
Methods: 13,673 consecutive neurosurgical operative admissions from 2013 to 2016 were analyzed. Patient payment data for hospital care and surgeon professional fees were extracted from the hospital administrative accounting program and the neurosurgeon private practice billing system, respectively. Analysis was performed using a multivariate mixed-effects linear regression model. Variables considered included patient age, sex, length-of-stay (LOS), case category, insurance type, SOI/ROM scores, and elective vs. emergency status.
Results: Patient age, insurance type, case category, and LOS were independent predictors of patient OOP spending (P<0.05). Anterior/lateral spinal fusion and cranial endoscopic operations were associated with the highest patient OOP spending for all patients ([mean±standard error]: $858±81 and $1,005±167, respectively), as well as for commercially-insured patients specifically ($1,662±165 and $1,637±298, respectively). Despite controlling for inflation, case mix, and patient mix, mean patient OOP spending grew 42% per patient encounter from 2013 to 2016 ($624±90 in 2013 to $886±98 in 2016, P=0.05). Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 59% ($1,161±179 in 2013 to $1,841±213 in 2016, P=0.009) (Figure 1).
Conclusions: Patient OOP spending for neurosurgical patients increased significantly from 2013 to 2016, representing increased healthcare costs and patient cost sharing in an evolving healthcare environment. Patients and providers can consider this information prior to surgery to better anticipate the financial burden of neurosurgical care. These findings deserve increased attention and analyses on a national level.
Patient Care: Patient financial burden is a critical component of healthcare delivery, as patient OOP spending has been reported to impact patients' healthcare decision making and quality-of-life following a diagnosis. To our knowledge, our study provides the most comprehensive, transparent analysis of patient OOP spending for neurosurgical care to date. These findings can be considered by patients and providers examining the potential financial burden of a neurosurgical operation, and policy makers considering changes to cost sharing infrastructure as the health insurance marketplace continues to evolve.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify the lack of data available on patient out-of-pocket (OOP) cost for neurosurgical care. 2) Discuss the rising OOP spending for neurosurgical care and consider the implications of this trend. 3) Identify next steps for analyzing these findings on a national level. 4) Consider future policy interventions that may help curtail this negative trend for neurosurgical patients.