A new study published in The Spine Journal examines how a patient's insurance status can affect patient safety for lumbar spinal fusion.
The study authors examined all inpatient lumbar fusion cases from 1998 to 2011 from the Nationwide Inpatient Sample. There were 539,172 adult lumbar fusion procedures recorded during that time. The study authors excluded the patients from their secondary analysis if the insurance status was "other" or "missing." The researchers found:
1. Patient safety events nationally are 2,445 per 100,000 patient years of observation — 2.5 percent.
2. The secondary analysis showed Medicare and self-pay patients had greater odds of one or more patient safety events than privately insured patients when controlling for patient demographics and hospital characteristics.
3. The study authors concluded for lumbar spine patients, "insurance status is associated with the adverse healthcare quality events used to determine hospital reimbursement by Medicare."
4. There could be a disparity because as is shown in Derakhshan et al., it's more difficult to achieve consent from the public insurers for additional advanced imaging. It's also possible physicians are less likely to seek the advanced imaging when patients have a less robust insurance, according to the report.
5. As healthcare moves toward value-based care, the patient safety events are used to determine the quality and value of care. Decreasing the patient safety events can increase quality and decrease costs. The study results "can be used to support initiatives designed to eliminate disparities by improving the quality of care delivered to vulnerable patient populations."