The cost per surgeon for spine surgery varies from surgeon-to-surgeon. But as a high-dollar procedure — accounting for $90 billion in healthcare expenditures in the United States — variation won't be tolerated in the move toward value-based care.
A new article published in Spine examines intersurgeon variation for 1,241 elective spine surgeries at one facility for three years. The researchers found:
1. There was an unadjusted cost per surgeon variation by a factor of 1.32 to 1.81 between lowest and highest cost surgeons. The cost depended on the procedure. The lowest variation was for posterior laminectomies and the highest was for posterior lumbar decompression and fusion.
2. The variation between surgeons was 1.31x when adjusting for patient features and procedure.
3. There were seven surgeons with sufficient patient volume, and one was significantly less costly than the others, costing $1,462 less per procedure.
4. Three surgeons cost more than average:
• Surgeon one: $685 more
• Surgeon two: $839 more
• Surgeon three: $702 more
5. The factors driving the total variation were largely supply and operating room costs; but the actual drivers were surgeon-specific. "Data on procedure-level variation should be discussed with individual surgeons to shift practice patterns," concluded the study authors. "Finally, the comparison methodology can be applied to other procedures and specialties."
Procedures examined in the study included anterior cervical discectomy and fusion, posterior lumbar decompression and fusion, posterior laminectomies and lumbar discectomies.