Current Procedural Terminology-based Procedure Categorization Enhances Cost Prediction of Medicare Severity Diagnosis Related Group in Spine Surgery.

作者: Griffin R. Baum , Geoffrey Stricsek , Mathu A. Kumarasamy , Vineeth Thirunavu , Gregory J. Esper

DOI: 10.1097/BRS.0000000000003801

关键词: Physical therapyCurrent Procedural TerminologyCategorizationMedicineDiagnosis-related groupReimbursementLinear regressionRetrospective cohort studyHealth careCoding (social sciences)

摘要: STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to analyze how a Current Procedural Terminology (CPT)-based categorization method can predict cost variation in surgical spine procedures. SUMMARY OF BACKGROUND DATA Neck and back disorders affect majority the adult population account for tens billions dollars health care spending each year. In era bundled payments value-based reimbursement, it is imperative surgeons identify sources variability across Historically, has been accomplished using Medicare Severity Diagnosis Related Group (MS-DRG) codes, but they utilize an overly simplistic specificity familiarity CPT coding structure makes better option categorizing differences decision making technique. METHODS Hospital billing data patients undergoing procedure requiring overnight, in-patient stay retrospectively collected over 4 fiscal years (2012-2016) from single system. Linear regression analysis performed assess correlation between and: spine-specific MS-DRG codes; novel CPT-based method; combination codes categorization. RESULTS There were 5020 procedures analyzed with respect 16 different 30 distinct categories (CSCs). results were: R2 = 0.6545 (P < 0.001); CSC R2 = 0.5709 R2 = 0.744 combined methods (P < 0.05). Median difference actual predicted model -$261.00, compared -$727.50 -$478.70 model. CONCLUSION Addition provides enhanced evaluate association when linear surgery.Level Evidence: 3.

参考文章(8)
G L Hallman, C Edmonds, CardioVascular Care Providers. A pioneer in bundled services, shared risk, and single payment. Texas Heart Institute Journal. ,vol. 22, pp. 72- 76 ,(1995)
Robert B. Fetter, Ronald E. Mills, Donald C. Riedel, John D. Thompson, The application of diagnostic specific cost profiles to cost and reimbursement control in hospitals. Journal of Medical Systems. ,vol. 1, pp. 137- 149 ,(1977) , 10.1007/BF02285281
Neeraj Sood, Peter J. Huckfeldt, José J. Escarce, David C. Grabowski, Joseph P. Newhouse, Medicare’s Bundled Payment Pilot For Acute And Postacute Care: Analysis And Recommendations On Where To Begin Health Affairs. ,vol. 30, pp. 1708- 1717 ,(2011) , 10.1377/HLTHAFF.2010.0394
Andrew J. Schoenfeld, Mitchel B. Harris, Haiyin Liu, John D. Birkmeyer, Variations in Medicare Payments for Episodes of Spine Surgery The Spine Journal. ,vol. 14, pp. 2793- 2798 ,(2014) , 10.1016/J.SPINEE.2014.07.002
J. Oren, L. H. Hutzler, T. Hunter, T. Errico, J. Zuckerman, J. Bosco, Decreasing spine implant costs and inter-physician cost variation: the impact of programme of cost containment on implant expenditure in spinal surgery Journal of Bone and Joint Surgery-british Volume. pp. 1102- 1105 ,(2015) , 10.1302/0301-620X.97B8.35333
Joseph L Dieleman, Ranju Baral, Maxwell Birger, Anthony L Bui, Anne Bulchis, Abigail Chapin, Hannah Hamavid, Cody Horst, Elizabeth K Johnson, Jonathan Joseph, Rouselle Lavado, Liya Lomsadze, Alex Reynolds, Ellen Squires, Madeline Campbell, Brendan DeCenso, Daniel Dicker, Abraham D Flaxman, Rose Gabert, Tina Highfill, Mohsen Naghavi, Noelle Nightingale, Tara Templin, Martin I Tobias, Theo Vos, Christopher JL Murray, None, US Spending on Personal Health Care and Public Health, 1996-2013. JAMA. ,vol. 316, pp. 2627- 2646 ,(2016) , 10.1001/JAMA.2016.16885
George Keel, Carl Savage, Muhammad Rafiq, Pamela Mazzocato, Time-driven activity-based costing in health care: A systematic review of the literature Health Policy. ,vol. 121, pp. 755- 763 ,(2017) , 10.1016/J.HEALTHPOL.2017.04.013