Length of Stay and Disposition of Patients Undergoing Elective Spine Surgery in Maryland: Impact of the Global Budget Revenue Program. (1st September 2019)

• Record Type: Journal Article
• Authors: Shammassian, Berje Haroutuon; Ahn, Andrew; Mukherjee, Debraj
• Is Part Of: Neurosurgery. Volume 66(2010)Supplement 1
• Publication Date: 2019-09-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz310_164
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: The State of Maryland implemented an All-Payer Global Budget Revenue (GBR) program in 2014. The policy shifted hospital reimbursement from diagnosis related groups (DRG) to set annual budgets prior to each fiscal year with the goal of reducing cost and utilization while improving patient outcomes. No studies have evaluated the impact on patients undergoing spine surgery, a growing population that can exhibit high costs. METHODS: A retrospective review was conducted utilizing the Maryland Health Services Cost Review Commission Public use dataset to evaluate differences in hospital length of stay (LOS), 30 d readmissions, and disposition locations of patients undergoing elective spine surgery at hospitals under the GBR Program in Maryland from 2012 to 2018. Hierarchical regression modeling was used to evaluate the outcomes prior to and following policy implementation. Outcomes included mean LOS, odds of readmission, and the relative risk of discharge to home with home health care (HHC) or rehabilitation (Rehab) compared to home. Covariates included sex, age, race, complexity, and mortality risk. RESULTS: A total of 31 068 records of elective spine surgery from 2012 to 2018 were identified. There was a statistically significant decrease in readmission rates following implementation of the global budget program, 2.57% to 2.02% P = .001. However, when clustering on hospitals, there was no significant difference in odds of readmission following policy implementation, Adjusted OR 0.76 (95% CI 0.48, 1.22). There was a statistically significant increase in the ratio of relative risks of discharge to HHC or Rehab comparing the period following policy implementation to before was 1.62 (95% CI 1.17, 2.23) and 2.07 (95% CI 1.38, 3.12), respectively. CONCLUSION: A preliminary analysis demonstrates no change in hospital utilization, but an increase in risk of being discharged with ancillary services or to rehabilitation among spine fusion patients following policy implementation. Further analysis is warranted to determine changes in trends to inform future policies.