Medicare’s spinal-deformity-specific diagnosis-related group distribution has some limitations when it comes to understanding the nuances of surgeries, according to a study in the March 1 edition of Spine.
Five things to know:
1. The analysis included 314 adult patients who underwent thoracic to pelvis instrumentation with associated DRGs. They were identified from a multicenter database, and variables including demographics, 90-day adverse events and reimbursement costs were compared between spinal deformity-specific DRG codes.
2. The majority of the patient fell into +CC DRGs, and a minority had +MCC DRGs or no MCC/CC DRG. In each DRG there was there was considerable heterogeneity in regard to patients’ ages, ASA, CCI, frailty, surgical invasiveness, postoperative ICU/hospital LOS, discharge disposition and complication profiles, according to the study.
3. The +MCC DRGs had “significantly greater ASA and Edmonton Frailty Scores” and +MCC and +CC had relatively similar surgical invasiveness.
4. Reimbursements were significantly higher for +MCC DRG compared with +CC DRGs and DRGs without MCC/CC, and there were large ranges in reimbursement within all DRG subgroups.
5. The study concluded, “While Medicare’s spinal-deformity DRG codes capture average trends in surgical/postoperative episodes of care for ASD patients, each encompasses highly heterogeneous patients and associated surgical operations rendering them unreliable gauges of patient/surgical complexity, early postoperative trajectories, and reimbursement costs. A more granular system is needed to more accurately capture the nuances of ASD operations and their associated quality metrics and reimbursement costs.”
