Implant Charges May Hike Hospital Charges for AIS Fusion

Recently presented research highlights an increase in hospital charges for fusion of patients with adolescent idiopathic scoliosis while utilization rates have remained constant and indicates implants are the primary driver of these increased charges.

“Hospital charges for [adolescent idiopathic scoliosis] AIS are increasing and they are increasing much faster than inflation rates, but utilization rates have been constant; and thus, increased utilization is not a driver of national expenditure for idiopathic scoliosis,” Christopher T. Martin, M.D., said in a presentation. “Nationally, we saw there has been a shift towards all posterior-based constructs. At our institution, the primary driver of increased charges was the implants and the pedicle screw contributed the most to that increase. At our hospital, the surgeon charges fell during every year of the study period.”

The investigators used the national Kid’s Inpatient Database to identify 24,500 cases of AIS fusion performed between 1997 and 2009 and compared the data against information for other pediatric and common spine admissions. To determine the drivers of charges, the researchers used their hospital’s billing records and reviewed 10 cases for each year of the study period and categorized every item billed as either a surgeon, implant or other charge. They adjusted the charges for inflation to the rate of the dollar in 2009.

The investigators observed that, relative to inflation, hospital charges for AIS fusion increased every year. However, they found charges for non-spine admissions were relatively stagnant. They discovered that utilization rates for AIS fusion were relatively constant, as well.

In addition, the study revealed a shift from anterior-based procedures to posterior-based spine surgeries between 2003 and 2009, which Martin noted corresponded with the adoption of pedicle screws in the United States.

“At our hospital, the primary driver of increased charges was the implants,” Martin said. “Surgeon charges actually fell over the study period.”

He and his colleagues noted that charges for pedicle screws went up nearly six-fold per case during the study period, but charges for hooks fell. “Not only are we using a more expensive implant, we’re using more implants per level fused per case. So the implant density at our institution nearly doubled during the study period,” Martin said.

He added, “In the future, I think we should focus our efforts on outcomes and demonstrate value both for the procedures we do and the implants we choose,” Martin said. “For hospital administrators, it may be that the implants are an area for substantial cost savings.”