A new study investigates inpatient and 90-day post-discharge outcomes for elective Medicare spine fusion. The study included 874 hospitals with elective cervical and non-cervical spine fusions in the 2012 to 2014 Medicare limited dataset. Researchers focused on 167,395 cases.
The study analyzed the following risk-adjusted adverse outcomes: inpatient deaths; prolonged length-of-stay; 90-day post-discharge deaths; and 90-day post-discharge readmissions.
Donald Fry, MD, executive vice president for clinical outcomes management at MPA Healthcare Solutions, led the research. His team reported the following findings:
- Of cervical fusion patients, 15.9 percent experienced one or more adverse outcomes
- Of non-cervical fusion patients, 14.9 percent experienced one or more adverse outcomes
- Fifty-four hospitals possessed z-scores 2 better than predicted and a 9.2 percent median risk-adjusted adverse outcome rate
- Seventy-five hospitals had z-scores 2 worse than predicted and a 23.2 percent median risk-adjusted adverse outcome rate
"We have demonstrated by risk adjusting adverse outcomes in spine fusion surgery, there is substantial variability in outcomes by different hospitals across the country," says Dr. Fry. "The difference defines for us what the opportunity for improvement happens to be."
This paper supports the idea that the healthcare industry should be looking at risk-adjusted data and comparing high-performing facilities to suboptimal-performing facilities. Dr. Fry stresses a main problem is many surgeons aren't aware of their 90-day post-discharge results.
"It is imperative that providers know what their results are and how they benchmark against other providers," Dr. Fry says. "That, in and of itself, will serve as a major impetus to improve outcomes of care."
Dr. Fry has authored a series of papers similar to this analysis, on cardiac surgery and colon surgery, so the results did not startle him. His previous work revealed the same divergence between institutions.
"I continue to be troubled [though], by the fact that we have such wide discrepancies in outcomes among the facilities in the country," he notes. The adverse outcomes one hospital experiences likely aren't a "carbon copy" of another, Dr. Fry suggests. Therefore, hospitals should hone in on remedies for specific areas of poor performance as opposed to a blanket improvement strategy. For example, one hospital may have high readmissions while another has extended length-of-stays.
"Improvement requires focus on the specific adverse events that you experience in your hospitals, and I don't think there is an overall broad-based template that should be applied for improvement," cautions Dr. Fry.
In essence, don't alter practices in areas in which a hospital is doing quite well. It is critical hospitals get a handle on their outcomes as alterative payment models continue to evolve.
"Bad complications and readmissions are going to become a financial liability," concludes Dr. Fry.