需要更好地了解成本和医疗保健资源利用(HCRU)的前后趋势,以更好地告知患者期望并帮助制定策略,以最大程度地减少与腰椎手术相关的重大医疗保健负担。
在一个大型国家索赔队列中,检查选择性腰椎狭窄手术前后2年的成本和HCRU的时间过程。
行政索赔数据库(IBM®Marketscan®ResearchDatabases2007-2015)的回顾性分析。
接受选择性单级腰椎狭窄手术的成年患者,术前和术后至少2年连续健康计划入组。
功能措施,包括HCLU(15类)的月费率,每月总承保付款(包括健康计划的付款以及患者支付的自付额和共同保险),按HRU类别,以及脊柱与非脊柱相关的。
所有可用的患者均用于HCRU的分析。为了分析付款,仅分析了提供准确财务信息的未写明健康计划的患者.使用消费者价格指数的医疗保健部分将付款转换为2015年美元。每月在手术前后绘制付款和HCRU的趋势,并使用回归模型进行评估。与人口统计的关系,手术因素,并用多变量重复测量广义估计方程评估合并症。
手术前2年的平均每月医疗费用为275美元(22美元,868美元)。术前2年的基线HCRU稳定或仅逐渐上升(办公室就诊,处方药使用),但在手术前6到12个月开始在许多类别中急剧上升。每月付款在手术前6个月开始急剧上升,在手术前一个月达到1,402美元(634美元,2,827美元)的峰值。这是由于放射学的增加,办公室访问,PT,注射,处方药,ER遭遇,和住院。手术后付款立即急剧下降。在剩下的两年里,付款总额中位数仅略有下降,由于脊柱相关支付的持续下降被随着患者年龄增长而逐渐增加的非脊柱相关支付所抵消.术后2年,使用PT和注射的患者百分比恢复到术前2年观察到的基线水平的1%以内;然而,与脊柱相关的处方药使用率仍然升高,其他类别的HCCU(放射学,办公室访问,实验室/诊断服务,以及住院等罕见事件,ER遭遇,和SNF/IRF)。具有手术融合成分的患者术前支付较高,并且HCRU,这并没有解决术后。付款和HCCU的变化在计划类型之间也很明显,患者接受全面的医疗计划-主要是雇主赞助的补充医疗保险保险-利用更多的住院患者,ER,以及住院康复和熟练护理设施。高免赔额计划的患者在所有类别中的付款和HCRU较少;然而,我们无法区分这是因为他们使用了较少的这些服务,还是他们在没有向付款人提交的情况下自掏腰包支付这些服务。术后2年,51%的患者没有与脊柱相关的每月付款,而术前2年,33%的患者每月支付较高,16%的患者每月支付较低。
这是第一项研究,旨在描述脊柱手术前后长期内直接医疗支付和HCRU的时间趋势。计划类型之间的差异可能凸显了患者在获得护理和计划相关财务中介方面的差异。
Improved understanding of the pre- and postoperative trends in costs and healthcare resource utilization (HCRU) is needed to better inform patient expectations and aid in the development of strategies to minimize the significant healthcare burden associated with lumbar spine surgery.
Examine the time course of costs and HCRU in the 2 years preceding and following elective lumbar spine surgery for stenosis in a large national claims cohort.
Retrospective analysis of an administrative claims database (IBM® Marketscan® Research Databases 2007-2015).
Adult patients undergoing elective primary single-level lumbar surgery for stenosis with at least 2 years of continuous health plan enrollment pre- and postoperatively.
Functional measures, including monthly rates of HCRU (15 categories), monthly gross covered payments (including payments made by the health plan and deductibles and coinsurance paid by the patient) overall, by HCRU category, and by spine versus non-spine-related.
All available patients were utilized for analysis of HCRU. For analysis of payments, only patients on noncapitated health plans providing accurate financial information were analyzed. Payments were converted to 2015 United States dollars using the medical care component of the consumer price index. Trends in payments and HCRU were plotted on a monthly basis pre- and post-surgery and assessed with regression models. Relationships with demographics, surgical factors, and comorbidities were assessed with multivariable repeated measures generalized estimating equations.
Median monthly healthcare payments 2 years prior to surgery were $275 ($22, $868). Baseline HCRU at 2 years preoperatively was stable or only gradually rising (office visits, prescription drug use), but began an increasingly steep rise in many categories 6 to 12 months prior to surgery. Monthly payments began an increasingly steep rise 6 months prior to surgery, reaching a peak of $1,402 ($634, $2,827) in the month prior to surgery. This was driven by an increase in radiology, office visits, PT, injections, prescription medications, ER encounters, and inpatient admissions. Payments dropped dramatically immediately following surgery. Over the remainder of the 2 years, the median total payments declined only slightly, as a continued decline in spine-related payments was offset by gradually increased non-spine related payments as patients aged. By 2 years postoperatively, the percentage of patients using PT and injections returned to within 1% of the baseline levels observed 2 years preoperatively; however, spine-related prescription medication use remained elevated, as did other categories of HCRU (radiology, office visits, lab/diagnostic services, and also rare events such as inpatient admissions, ER encounters, and SNF/IRF). Patients with a fusion component to their surgeries had higher payments and HCRU preoperatively, and this did not resolve postoperatively. Variations in payments and HCRU were also evident among plan types, with patients on comprehensive medical plans-predominantly employer-sponsored supplemental Medicare coverage-utilizing more inpatient, ER, and inpatient rehabilitation & skilled nursing facilities. Patients on high-deductible plans had fewer payments and HCRU across all categories; however, we are unable to distinguish whether this is because they used fewer of these services or if they were paying for these services out of pocket without submitting to the payer. By 2 years postoperatively, 51% of patients had no spine-related monthly payments, while 33% had higher and 16% had lower monthly payments relative to 2 years preoperatively.
This is the first study to characterize time trends in direct healthcare payments and HCRU over an extended period preceding and following spine surgery. Differences among plan types potentially highlight disparities in access to care and plan-related financial mediators of patients\' healthcare resource utilization.