Kaye I David, Adrados Murillo, Karia Raj J, Protopsaltis Themistocles S, Bosco Joseph A
New York University Langone Medical Center-Hospital for Joint Diseases, New York, NY.
Clin Spine Surg. 2017 Nov;30(9):407-412. doi: 10.1097/BSD.0000000000000587.
Observational database review.
To determine the effect of patient severity of illness (SOI) on the cost of spine surgery among New York state hospitals.
National health care spending has risen at an unsustainable rate with musculoskeletal care, and spine surgery in particular, accounting for a significant portion of this expenditure. In an effort towards cost-containment, health care payers are exploring novel payment models some of which reward cost savings but penalize excessive spending. To mitigate risk to health care institutions, accurate cost forecasting is essential. No studies have evaluated the effect of SOI on costs within spine surgery.
The New York State Hospital Inpatient Cost Transparency Database was reviewed to determine the costs of 69,831 hospital discharges between 2009 and 2011 comprising the 3 most commonly performed spine surgeries in the state. These costs were then analyzed in the context of the specific all patient refined diagnosis-related group (DRG) SOI modifier to determine this index's effect on overall costs.
Overall, hospital-reported cost increases with the patient's SOI class and patients with worse baseline health incur greater hospital costs (P<0.001). Moreover, these costs are increasingly variable for each worsening SOI class (P<0.001). This trend of increasing costs is persistent for all 3 DRGs across all 3 years studied (2009-2011), within each of the 7 New York state regions, and occurs irrespective of the hospital's teaching status or size.
Using the 3M all patient refined-DRG SOI index as a measure of patient's health status, a significant increase in cost for spine surgery for patients with higher SOI index was found. This study confirms the greater cost and variability of spine surgery for sicker patients and illustrates the inherent unpredictability in cost forecasting and budgeting for these same patients.
观察性数据库回顾。
确定纽约州医院中患者疾病严重程度（SOI）对脊柱手术费用的影响。
国家医疗保健支出以不可持续的速度增长，其中肌肉骨骼护理，尤其是脊柱手术，占了这一支出的很大一部分。为了控制成本，医疗保健支付方正在探索新的支付模式，其中一些模式奖励成本节约但惩罚过度支出。为了降低医疗机构的风险，准确的成本预测至关重要。尚无研究评估SOI对脊柱手术成本的影响。
回顾纽约州医院住院患者成本透明度数据库，以确定2009年至2011年间69,831例医院出院病例的成本，这些病例包括该州最常进行的3种脊柱手术。然后，在特定的所有患者精细化诊断相关组（DRG）SOI修正因子的背景下分析这些成本，以确定该指数对总成本的影响。
总体而言，医院报告的成本随着患者的SOI等级增加而增加，基线健康状况较差的患者产生的医院成本更高（P<0.001）。此外，随着SOI等级每恶化一级，这些成本的变异性越来越大（P<0.001）。在研究的所有3年（2009 - 2011年）中，对于所有3个DRG，在纽约州的7个地区中的每一个地区内，成本增加的这一趋势都是持续的，并且无论医院的教学地位或规模如何都会出现。
使用3M所有患者精细化DRG SOI指数作为患者健康状况的衡量标准，发现SOI指数较高的患者脊柱手术成本显著增加。这项研究证实了病情较重的患者进行脊柱手术的成本更高且变异性更大，并说明了对这些相同患者进行成本预测和预算时固有的不可预测性。
