Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA.
Neurosurgery. 2024 Oct 1;95(4):779-788. doi: 10.1227/neu.0000000000002951. Epub 2024 Apr 29.
Bundled payment for care improvement advanced (BPCIA) is a voluntary alternative payment model administered by the Centers for Medicare and Medicaid Services using value-based care to reduce costs by incentivizing care coordination and improved quality. We aimed to identify drivers of negative financial performance in BPCIA among patients undergoing spinal fusion surgery.
This is a single-institution retrospective review of patients enrolled in BPCIA undergoing spinal fusion with DRGs 453, 454, 455, 459, and 460 from 2018 to 2022. Univariate and multivariable logistic regression analyses were used to identify factors associated with negative financial performance and compare nonelective vs elective surgeries.
We identified 172 cases, of which 24% (n = 41) had negative financial performance and 9% (n = 16) were nonelective cases. Nonelective surgery (P < .001, odds ratios 19.81), greater levels instrumented (P < .001), and no anterior procedure (P = .001) were associated with negative financial performance. Surgical outcomes associated with negative financial performance and factors more common in nonelective cases respectively included higher hospital length of stay (P < .001, P = .005), nonhome discharge (P < .001, P < .001), 90-day hospital readmission (P < .001, P < .001), 90-day additional nonspine surgery (P = .01, P < .001), and less days at home of the 90 days (P < .001, P = .01). Nonelective surgeries had higher total spend (P = .01), readmission spend (P = .03), skilled nursing facility spend (P = .02), durable medical equipment spend (P = .003), and professional billing spend (P = .04) despite similar target pricing (P = .60), all of which resulted in greater financial loss compared with elective surgeries (P = .001).
Nonelective spinal surgery is an independent preoperative predictor of negative financial performance in BPCIA. Nonelective spinal surgeries are more likely than elective surgeries to have higher length of stay, nonhome discharge, 90-day hospital readmission, 90-day additional nonspine surgeries, and less time spent at home during the bundled period, all of which contribute to higher health care utilization. The Centers for Medicare and Medicaid Services should consider incorporating nonelective spine surgery into risk-adjustment models.
医保捆绑支付改善计划（BPCIA）是由医疗保险和医疗补助服务中心管理的一种自愿性的替代支付模式，通过基于价值的护理来激励护理协调和提高质量，从而降低成本。我们旨在确定在接受脊柱融合手术的患者中，BPCIA 中出现负财务绩效的驱动因素。
这是一项对 2018 年至 2022 年期间接受 DRG 453、454、455、459 和 460 脊柱融合术的 BPCIA 患者进行的单机构回顾性研究。使用单变量和多变量逻辑回归分析来确定与负财务绩效相关的因素，并比较非选择性手术与选择性手术。
我们共确定了 172 例病例，其中 24%（n=41）出现负财务绩效，9%（n=16）为非选择性手术。非选择性手术（P<0.001，比值比 19.81）、更多的器械使用（P<0.001）和无前路手术（P=0.001）与负财务绩效相关。与负财务绩效相关的手术结果和更常见于非选择性手术的因素分别包括更高的住院时间（P<0.001，P=0.005）、非家庭出院（P<0.001，P<0.001）、90 天内医院再入院（P<0.001，P<0.001）、90 天内额外的非脊柱手术（P=0.01，P<0.001）和 90 天内更少的在家天数（P<0.001，P=0.01）。非选择性手术的总支出（P=0.01）、再入院支出（P=0.03）、熟练护理设施支出（P=0.02）、耐用医疗设备支出（P=0.003）和专业计费支出（P=0.04）更高，尽管目标定价相似（P=0.60），但所有这些都导致与选择性手术相比，财务损失更大（P=0.001）。
非选择性脊柱手术是 BPCIA 中负财务绩效的独立术前预测因素。与选择性手术相比，非选择性脊柱手术更有可能出现更高的住院时间、非家庭出院、90 天内医院再入院、90 天内额外的非脊柱手术以及在捆绑期内更少的在家时间，所有这些都导致更高的医疗保健利用率。医疗保险和医疗补助服务中心应考虑将非选择性脊柱手术纳入风险调整模型。
