Singh Siddhartha, Sparapani Rodney, Wang Marjorie C
Departments of1Medicine.
2Biostatistics, and.
J Neurosurg Spine. 2018 Sep;29(3):286-291. doi: 10.3171/2018.1.SPINE171064. Epub 2018 Jun 1.
OBJECTIVE Pay-for-performance programs are targeting hospital readmissions. These programs have an underlying assumption that readmissions are due to provider practice patterns that can be modified by a reduction in reimbursement. However, there are limited data to support the role of providers in influencing readmissions. To study this, the authors examined variations in readmission rates by spine surgeon within 30 days among Medicare beneficiaries undergoing elective lumbar spine surgery for degenerative conditions. METHODS The authors applied validated ICD-9-CM algorithms to 2003-2007 Medicare data to select beneficiaries undergoing elective inpatient lumbar spine surgery for degenerative conditions. Mixed models, adjusting for patient demographics, comorbidities, and surgery type, were used to estimate risk of 30-day readmission by the surgeon. Length of stay (LOS) was also studied using these same models. RESULTS A total of 39,884 beneficiaries were operated on by 3987 spine surgeons. The mean readmission rate was 7.2%. The mean LOS was 3.1 days. After adjusting for patient characteristics and surgery type, 1 surgeon had readmission rates significantly below the mean, and only 5 surgeons had readmission rates significantly above the mean. In contrast, for LOS, the patients of 288 surgeons (7.2%) had LOS significantly lower than the mean, and the patients of 397 surgeons (10.0%) had LOS significantly above the mean. These findings were robust to adjustments for surgeon characteristics and clustering by hospital. Similarly, hospital characteristics were not significantly associated with readmission rates, but LOS was associated with hospital for-profit status and size. CONCLUSIONS The authors found almost no variations in readmission rates by surgeon. These findings suggest that surgeon practice patterns do not affect the risk of readmission. Likewise, no significant variation in readmission rates by hospital characteristics were found. Strategies to reduce readmissions would be better targeted at factors other than providers.
绩效薪酬方案旨在降低医院再入院率。这些方案有一个潜在假设，即再入院是由于医疗服务提供者的执业模式所致，可通过减少报销来加以改变。然而，支持医疗服务提供者在影响再入院方面作用的数据有限。为研究这一问题，作者调查了因退行性疾病接受择期腰椎手术的医疗保险受益人群中，脊柱外科医生在30天内的再入院率差异。方法：作者将经过验证的ICD-9-CM算法应用于2003 - 2007年医疗保险数据，以筛选出因退行性疾病接受择期住院腰椎手术的受益人。使用混合模型，并对患者人口统计学、合并症和手术类型进行调整，以估计外科医生导致30天再入院的风险。还使用这些相同模型研究了住院时间（LOS）。结果：共有3987名脊柱外科医生为39884名受益人实施了手术。平均再入院率为7.2%。平均住院时间为3.1天。在对患者特征和手术类型进行调整后，1名外科医生的再入院率显著低于平均水平，只有5名外科医生的再入院率显著高于平均水平。相比之下，对于住院时间，288名外科医生（7.2%）的患者住院时间显著低于平均水平，397名外科医生（10.0%）的患者住院时间显著高于平均水平。这些发现对外科医生特征调整和医院聚类具有稳健性。同样，医院特征与再入院率无显著关联，但住院时间与医院的营利状况和规模有关。结论：作者发现外科医生的再入院率几乎没有差异。这些发现表明，外科医生的执业模式不会影响再入院风险。同样，未发现医院特征在再入院率方面有显著差异。降低再入院率的策略应更好地针对医疗服务提供者以外的因素。
