A new study published in Spine examines the cost variation within spinal fusion payment groups.
The study authors calculated hospital costs from the 2011 Nationwide Inpatient Sample for patients who underwent spinal fusion DRGs 453 to 460. They also examined total joint arthroplasty DRGs 466 to 470 to find cost variation.
A previous study concluded total joint arthroplasty DRGs had variation with differences between hospital cost and Medicare reimbursement, which could result in a financial loss for hospitals. For spinal fusions, the researchers found:
1. The coefficient of variation within spinal fusion DRGs ranged from 44.16 to 52.6. The spinal fusion coefficient of variation was significantly higher than the total joint arthroplasty benchmark coefficient of variation: 38.2.
2. The variation between spinal fusion DRGs could lead to differences in cost and reimbursement, ultimately placing financial burden on hospitals.
3. Cost variations could limit access to care for some spinal fusion patients, the study authors concluded.
4. The study authors recommended additional studies to find the factors behind the cost variation and determine whether changes could be made to "homogenize current payment groups and ensure equal access for all patients."
5. The current Medicare reimbursement for spinal surgery is based on DRGs that assume patients are members of a homogenous group and the payment can cover most patients in that group; however this study shows that assumption isn't necessarily the case.