Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA.
Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA.
Spine J. 2022 Jun;22(6):965-974. doi: 10.1016/j.spinee.2022.01.020. Epub 2022 Feb 3.
Improved understanding of the pre- and postoperative trends in costs and healthcare resource utilization (HCRU) is needed to better inform patient expectations and aid in the development of strategies to minimize the significant healthcare burden associated with lumbar spine surgery.
Examine the time course of costs and HCRU in the 2 years preceding and following elective lumbar spine surgery for stenosis in a large national claims cohort.
STUDY DESIGN/SETTING: Retrospective analysis of an administrative claims database (IBM® Marketscan® Research Databases 2007-2015).
Adult patients undergoing elective primary single-level lumbar surgery for stenosis with at least 2 years of continuous health plan enrollment pre- and postoperatively.
Functional measures, including monthly rates of HCRU (15 categories), monthly gross covered payments (including payments made by the health plan and deductibles and coinsurance paid by the patient) overall, by HCRU category, and by spine versus non-spine-related.
All available patients were utilized for analysis of HCRU. For analysis of payments, only patients on noncapitated health plans providing accurate financial information were analyzed. Payments were converted to 2015 United States dollars using the medical care component of the consumer price index. Trends in payments and HCRU were plotted on a monthly basis pre- and post-surgery and assessed with regression models. Relationships with demographics, surgical factors, and comorbidities were assessed with multivariable repeated measures generalized estimating equations.
Median monthly healthcare payments 2 years prior to surgery were $275 ($22, $868). Baseline HCRU at 2 years preoperatively was stable or only gradually rising (office visits, prescription drug use), but began an increasingly steep rise in many categories 6 to 12 months prior to surgery. Monthly payments began an increasingly steep rise 6 months prior to surgery, reaching a peak of $1,402 ($634, $2,827) in the month prior to surgery. This was driven by an increase in radiology, office visits, PT, injections, prescription medications, ER encounters, and inpatient admissions. Payments dropped dramatically immediately following surgery. Over the remainder of the 2 years, the median total payments declined only slightly, as a continued decline in spine-related payments was offset by gradually increased non-spine related payments as patients aged. By 2 years postoperatively, the percentage of patients using PT and injections returned to within 1% of the baseline levels observed 2 years preoperatively; however, spine-related prescription medication use remained elevated, as did other categories of HCRU (radiology, office visits, lab/diagnostic services, and also rare events such as inpatient admissions, ER encounters, and SNF/IRF). Patients with a fusion component to their surgeries had higher payments and HCRU preoperatively, and this did not resolve postoperatively. Variations in payments and HCRU were also evident among plan types, with patients on comprehensive medical plans-predominantly employer-sponsored supplemental Medicare coverage-utilizing more inpatient, ER, and inpatient rehabilitation & skilled nursing facilities. Patients on high-deductible plans had fewer payments and HCRU across all categories; however, we are unable to distinguish whether this is because they used fewer of these services or if they were paying for these services out of pocket without submitting to the payer. By 2 years postoperatively, 51% of patients had no spine-related monthly payments, while 33% had higher and 16% had lower monthly payments relative to 2 years preoperatively.
This is the first study to characterize time trends in direct healthcare payments and HCRU over an extended period preceding and following spine surgery. Differences among plan types potentially highlight disparities in access to care and plan-related financial mediators of patients' healthcare resource utilization.
为了更好地了解腰椎手术前后的成本和医疗资源利用（HCRU）的变化趋势，从而更好地告知患者的期望，并帮助制定策略，以尽量减少与腰椎手术相关的巨大医疗负担，这是非常有必要的。
在一个大型全国性索赔队列中，研究腰椎狭窄症择期单节段腰椎手术前 2 年和后 2 年的成本和 HCRU 时间变化过程。
研究设计/设置：对 IBM® Marketscan® Research Databases 2007-2015 的行政索赔数据库进行回顾性分析。
至少有 2 年连续健康计划入组的，接受择期初次单节段腰椎手术治疗狭窄症的成年患者。
功能指标，包括每月 HCRU（15 个类别）的比率，每月的总覆盖支付（包括健康计划支付的金额以及患者支付的免赔额和共付额），HCRU 类别，以及脊柱与非脊柱相关的支付。
所有可用患者均用于 HCRU 分析。对于支付分析，仅对非统包健康计划的患者进行分析，这些计划能提供准确的财务信息。使用消费者物价指数中的医疗保健部分将支付转换为 2015 年的美元。在手术前后，根据回归模型按月绘制支付和 HCRU 的趋势，并进行评估。使用多变量重复测量广义估计方程评估与人口统计学、手术因素和合并症的关系。
术前 2 年的每月医疗保健支付中位数为 275 美元（22 美元，868 美元）。基线 HCRU 在术前 2 年保持稳定或仅逐渐上升（门诊就诊、处方药使用），但在手术前 6 至 12 个月开始急剧上升。每月支付在手术前 6 个月开始急剧上升，在手术前 1 个月达到峰值 1402 美元（634 美元，2827 美元）。这是由放射学、门诊就诊、物理治疗、注射、处方药物、急诊室就诊和住院入院的增加所驱动的。手术后立即大幅下降。在接下来的 2 年中，总支付中位数仅略有下降，因为随着患者年龄的增长，脊柱相关支付的持续下降被非脊柱相关支付的逐渐增加所抵消。术后 2 年，接受物理治疗和注射治疗的患者比例恢复到术前 2 年观察到的基线水平的 1%以内；然而，脊柱相关药物的使用仍然较高，其他 HCRU 类别（放射学、门诊就诊、实验室/诊断服务以及罕见事件，如住院、急诊室就诊和康复护理和熟练护理设施）也是如此。手术中包含融合组件的患者术前支付和 HCRU 更高，术后并未解决。不同计划类型之间的支付和 HCRU 也存在差异，全面医疗计划（主要是雇主赞助的补充 Medicare 覆盖）的患者使用更多的住院、急诊和住院康复和熟练护理设施。高免赔额计划的患者在所有类别中支付和 HCRU 较少；然而，我们无法区分这是因为他们使用了这些服务较少，还是因为他们自费支付了这些服务而没有向付款人提交。术后 2 年，51%的患者没有脊柱相关的每月支付，而 33%的患者每月支付较高，16%的患者每月支付较低，与术前 2 年相比。
这是第一项描述腰椎手术后前后较长时间内直接医疗保健支付和 HCRU 时间变化趋势的研究。不同计划类型之间的差异可能突出了获得医疗保健的差异和与计划相关的患者医疗资源利用的财务中介。
