Impact of Race/Ethnicity on Hospital Resource Utilization After Elective Anterior Cervical Decompression and Fusion for Degenerative Myelopathy

Abstract

Introduction: With the advent of bundled care payments for spine surgery, there is increasing scrutiny on the costs and resource utilization associated with surgical care. The purpose of this study was to compare (1) the total cost of the hospital episode of care and (2) discharge destination between White, Black, and Hispanic patients receiving elective anterior cervical decompression and fusion for degenerative cervical myelopathy (DCM) in Medicare patients. Methods: The 2019 Medicare Provider Analysis and Review Limited Data Set and the 2019 Impact File were used for this project. Multivariate models were created for total cost and discharge destination, controlling for confounders found on univariate analysis. We then performed a subanalysis for differences in specific cost-center charges. Results: There were 11,506 White (85.4%), 1,707 Black (12.7%), and 261 Hispanic (1.9%) patients identified. There were 6,447 males (47.8%) and 7,027 females (52.2%). Most patients were between 65 to 74 years of age (n = 7,101, 52.7%). The mean cost of the hospital episode was $20,919 6 11,848. Most patients were discharged home (n = 11,584, 86.0%). Race/ethnicity was independently associated with an increased cost of care (Black: $783, Hispanic: $1,566, P = 0.001) and an increased likelihood of nonhome discharge (Black: adjusted odds ratio: 1.990, P , 0.001, Hispanic: adjusted odds ratio: 1.822, P , 0.001) compared with White patients. Compared with White patients, Black patients were charged more for accommodations ($1808

Conversion THA With Concomitant Removal of Orthopaedic Hardware Should Be Reclassified as a Revision Surgery in the Medicare Severity Diagnosis-Related Group Coding Scheme: An Analysis of Cost and Resource Use

“…Our goal, however, was not to report a specific value of hospital costs, but to study the relationship between the costs of conversion THA and revision THA. Cost-to-charge ratios are a reasonable proxy for hospital resource consumption that have been used in medical research and they are sufficient for this purpose [3, 5, 11-13, 15, 16, 18, 21, 26-28, 31, 32, 39, 40, 46]. Because hospital costs may be influenced by multiple identifiable and nonidentifiable sources of cost variation [3, 4, 6, 7, 21, 22, 38, 42, 47], the benefit of using cost-to-charge ratios as our method of cost estimation was that it allowed us to analyze a large national dataset to mitigate the effects of random cost variation resulting from unique hospital practices and patient populations.…”

“…Hospital costs incurred during the acute hospitalization were estimated by multiplying total hospital charges obtained from the MEDPAR LDS by cost-to-charge ratios obtained from the Impact File for 2019. This is a validated method published by the CMS’s Research Data Assistance Center and used in medical research [3, 5, 11-13, 15, 16, 18, 21, 26-28, 31, 32, 39, 40, 46]. The cost-to-charge ratios used in our analysis were calculated by the CMS specifically for use with Medicare claims data.…”

Elective THA for Indications Other Than Osteoarthritis Is Associated With Increased Cost and Resource Use: A Medicare Database Study of 135,194 Claims

“…Our objective was not to provide an exact accounting of hospital costs, but to investigate the relative differences between costs. Cost-to-charge ratios are a reasonable proxy for hospital resource consumption and have been used in medical research [6, 8, 14, 15, 18, 20, 23, 28-30, 35, 37, 42, 43], and we believe they are sufficient for this purpose. The benefit of using cost-to-charge ratios was that it allowed us to access a large administrative database and decrease the influence of random cost variation through the law of large numbers.…”

“…The use of cost-to-charge ratios was originally developed by the Agency for Healthcare Research and Quality [22]. The method used in the present study was published by the CMS Research Data Assistance Center and used previous healthcare economics research [6, 8, 14, 15, 18, 20, 23, 28-30, 35, 37, 42, 43]. The cost-to-charge ratios in the Impact File were calculated by the CMS specifically for use with Medicare claims data.…”