Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Neurosurgery. 2022 Dec 1;91(6):961-968. doi: 10.1227/neu.0000000000002140. Epub 2022 Sep 19.
Previous studies have characterized utilization rates and cost of adult spinal deformity (ASD) surgery, but the differences between these factors in commercially insured and Medicare populations are not well studied.
To identify predictors of increased payments for ASD surgery in commercially insured and Medicare populations.
We identified adult patients who underwent fusion for ASD, 2007 to 2015, in 20% Medicare inpatient file (n = 21 614) and MarketScan commercial insurance database (n = 38 789). Patient age, sex, race, insurance type, geographical region, Charlson Comorbidity Index, and length of stay were collected. Outcomes included predictors of increased payments, surgical utilization rates, total cost (calculated using Medicare charges and hospital-specific charge-to-cost ratios), and total Medicare and commercial payments for ASD.
Rates of fusion increased from 9.0 to 8.4 per 10 000 in 2007 to 20.7 and 18.2 per 10 000 in 2015 in commercial and Medicare populations, respectively. The Medicare median total charges increased from $88 106 to $144 367 (compound annual growth rate, CAGR: 5.6%), and the median total cost increased from $31 846 to $39 852 (CAGR: 2.5%). Commercial median total payments increased from $58 164 in 2007 to $64 634 in 2015 (CAGR: 1.2%) while Medicare median total payments decreased from $31 415 in 2007 to $25 959 in 2015 (CAGR: -2.1%). The Northeast and Western regions were associated with higher payments in both populations, but there is substantial state-level variation.
Rate of ASD surgery increased from 2007 to 2015 among commercial and Medicare beneficiaries. Despite increasing costs, Medicare payments decreased. Age, length of stay, and BMP usage were associated with increased payments for ASD surgery in both populations.
先前的研究已经对成人脊柱畸形（ASD）手术的使用率和成本进行了描述，但在商业保险和医疗保险人群中，这些因素的差异尚未得到充分研究。
确定商业保险和医疗保险人群中 ASD 手术费用增加的预测因素。
我们在 20%的医疗保险住院文件（n=21614）和 MarketScan 商业保险数据库（n=38789）中，确定了 2007 年至 2015 年间接受 ASD 融合手术的成年患者。收集患者年龄、性别、种族、保险类型、地理位置、Charlson 合并症指数和住院时间等数据。结果包括增加支付的预测因素、手术利用率、总费用（使用医疗保险收费和医院特定的收费与成本比计算）以及 ASD 的医疗保险和商业总支付。
商业保险和医疗保险人群中融合手术的比例从 2007 年的每 10000 人 9.0 例分别增加到 2015 年的每 10000 人 8.4 例和每 10000 人 18.2 例。医疗保险的总收费中位数从 2007 年的 88106 美元增加到 2015 年的 144367 美元（复合年增长率为 5.6%），总费用中位数从 2007 年的 31846 美元增加到 2015 年的 39852 美元（复合年增长率为 2.5%）。商业保险的总支付中位数从 2007 年的 58164 美元增加到 2015 年的 64634 美元（复合年增长率为 1.2%），而医疗保险的总支付中位数从 2007 年的 31415 美元减少到 2015 年的 25959 美元（复合年增长率为-2.1%）。东北地区和西部地区在两个群体中都与较高的支付相关，但存在大量的州际差异。
从 2007 年到 2015 年，商业保险和医疗保险受益人的 ASD 手术率有所增加。尽管成本不断增加，但医疗保险的支付却有所减少。年龄、住院时间和 BMP 使用与两个群体中 ASD 手术费用的增加有关。
