The Ohio State University Wexner Medical Center, Columbus, OH.
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL.
Spine (Phila Pa 1976). 2018 May 15;43(10):720-731. doi: 10.1097/BRS.0000000000002405.
Retrospective, economic analysis.
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.
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.
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.
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.
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.
回顾性经济分析。
本研究旨在分析 2005 年至 2014 年间 Medicare 样本人群中颈椎和腰椎融合术的医院收费和支付情况，以及其与相应外科医生收费和支付的变化趋势。
先前的研究报告了脊柱融合术的医院收费和支付情况的趋势和变化，但没有一项研究将外科医生的数据纳入分析。随着我们向捆绑支付模式转变，了解医院和外科医生之间的财务关系将对利益相关者非常重要。
本研究使用 Medicare 5%的抽样数据，收集了 2005 年至 2014 年期间因退行性疾病进行颈椎和腰椎融合术的医院和外科医生的收费和支付情况。我们将医院收费乘数（CM）定义为医院/外科医生收费之比。同样，将医院/外科医生支付比率定义为医院支付乘数（PM）。分别对所有融合方法进行了逐年和区域的患者特征、住院时间、出院处置、CM 和 PM 的趋势研究。
共纳入 40965 例患者，分为 15854 例颈椎融合术和 25111 例腰椎融合术。从 2005 年到 2014 年，所有融合术的医院收费和支付均持续高于外科医生，且与医院住院时间呈反比。前-后颈椎融合术等融合术式的复杂性增加，导致医院每支付外科医生 1 美元，获得的报酬就越高。医院每收取外科医生 1 美元的收费情况在不同地区存在差异。
尽管所有融合术的住院时间都在减少，但医院相对于外科医生的收费和支付呈上升趋势。尽管医院可以为高风险患者获得更高的支付，但外科医生的支付并没有相应地反映出这种风险。随着向基于价值的医疗保健模式转变，共同承担结果和成本的责任，医院和提供者之间的激励机制可能需要更好地协调。
3 级
