Centers for Medicare & Medicaid Services Hierarchical Condition Category score as a predictor of readmission and reoperation following elective inpatient spine surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>A universal, objective predictor of postoperative resource utilization following inpatient spine surgery has not been clearly established. The Centers for Medicare &amp; Medicaid Services (CMS) Hierarchical Condition Category (HCC) risk adjustment model, based on a formula using patient demographics and coded diagnoses, is currently used to prospectively estimate financial risk in Medicare Advantage patients; however, the value of this score as a clinical tool is currently unknown. The authors present an analysis evaluating the utility of the CMS HCC score as a universal predictive tool for patients undergoing inpatient spine surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A total of 1966 consecutive patients (551 with lumbar laminectomy [LL] alone, 592 with lumbar laminectomy and fusion [LF], and 823 with anterior cervical discectomy and fusion [ACDF]) undergoing inpatient spine surgery at a single institution from January 2014 to May 2018 were included in this retrospective outcomes study. Perioperative outcome measures included procedure time, 30-day readmission, reoperation, hospital length of stay (LOS), opioid utilization measured by morphine milligram equivalents (MMEs), and cost of inpatient hospitalization (in US dollars). Published CMS algorithms were incorporated into the electronic health records and used to calculate HCC scores for all patients. Patients were stratified into HCC score quartiles. Linear regression was performed on LOS, procedure time, inpatient opioid consumption, discharge opioid prescriptions, and cost to identify predictors of HCC quartiles when controlling for procedure type. One-way ANOVA and Pearson’s chi-square analysis were used to compare perioperative outcomes stratified by HCC score.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Across all procedures, the HCC score demonstrated significant association with 30-day readmission (OR 1.45, 95% CI 1.11–1.91, p = 0.007). The average BMI, median American Society of Anesthesiologists score, and 30-day readmission rate were similar across procedures (LL: 30.6 kg/m<jats:sup>2</jats:sup>, 2, 3.6%; LF: 30.6 kg/m<jats:sup>2</jats:sup>, 2, 4.6%; ACDF: 30.2 kg/m<jats:sup>2</jats:sup>, 2, 3.9%; p = 0.265, 0.061, and 0.713, respectively). LOS (p &lt; 0.0001), duration of procedure (p &lt; 0.0001), discharge MME (p = 0.031), total cost (p &lt; 0.001), daily MME (p &lt; 0.001), reoperation (p &lt; 0.001), and 30-day readmission rate (p &lt; 0.001) were significantly different between HCC quartiles.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The HCC score may hold value as an objective, automated predictor of postoperative resource utilization and outcomes, including readmission and reoperation. This may have value as a universal, reproducible tool to target clinical interventions for higher-risk patients.</jats:p></jats:sec>

Lower Extremity Osteoarthritis: A Risk Factor for Mental Health Disorders, Prolonged Opioid Use, and Increased Resource Utilization After Single-Level Lumbar Spinal Fusion

“… 32 - 34 The first step toward improving the value is identifying populations at risk for increased utilization of these resources. In a previous study at our institution, 35 patients with increased comorbidity burden were found to have higher rates of 30-day readmissions after lumbar fusion, in alignment with multiple other studies. 36 , 37 Beyond overall comorbidity burden, increased age, female sex, preoperative levels of pain and function, socioeconomic factors, and a variety of individual comorbidities, including depression and anxiety, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and obesity, have all been linked with increased resource utilization and cost of care after lumbar fusion.…”

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Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model

“…Turcot et al recently published a report where they tested this model on patients that underwent different spinal surgical interventions. They found that there was a significant association between the HCC score and readmission rates, length of stay, need for reoperation, and cost [21].…”