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首页> 外文期刊>Neurosurgical focus >Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery
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Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery

机译：病例类型，住院时间，机构类型和合并症对成人脊椎畸形手术的医疗保险诊断相关小组报销的影响

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OBJECTIVE The aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery. METHODS Medicare’s Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion. RESULTS Pooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay. CONCLUSIONS Reimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.
机译：目的本研究的目的是教育医学专业人员有关在成人脊柱畸形（ASD）手术中使用不正确的诊断相关组（DRG）编码可能产生的财务影响。方法使用Medicare的住院预付费系统PC Pricer数据库收集了12家医院2015年ASD程序的报销数据。分析病例类型，医院类型/位置，手术级别数，正确的编码，住院时间和并发症/合并症（CC）对报销的影响。使用DRG将病例分为3种类型：1）仅前侧或后侧融合; 2）前侧融合与后经皮固定，无背侧融合; 3）前后结合与融合。结果合并机构，单级和多级ASD手术的报销费用相同。更长的逗留时间（从3天到8天）每次住宿额外收取$ 1400。后路融合术需要额外支付6588美元，而CC可以将报销费用增加约13,000美元。与私立院校相比，学术机构获得的报销更高，即约14,000美元（案例类型1和2）和约16,000美元（案例类型3）。与郊区机构相比，城市机构获得的报销较高，即大约$ 3000（案例类型1和2）和大约$ 3500（案例类型3）。逗留时间从3天延长到8天，私人机构的报销增加了208美元至494美元，学术机构每次住宿的报销增加了1397美元至1879美元。结论报销是基于不受外科医生或医院控制的许多因素，但是正确的DRG编码会显着影响医院的财务状况和优质患者护理的可用性。

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