Dexur analyzed Medicare Claims data and replicated CMS algorithms to calculate Medicare Spending per Beneficiary (MSPB) cost per episode of New Hanover Regional Medical Center and found that the cost per episode was $74,289 for Cervical Spinal Fusion from Jan-Dec 2019. The cost increased by 36.41% in 2019 to reach $74,289 compared to $54,460 in 2018. MSPB is the only measure under the Efficiency and Cost Reduction domain under the Value-Based Purchasing (VBP) Program and accounts for 25% of VBP adjustments.

The analysis was done at the DRG level to implement risk adjustment, specifically for DRG 682: Renal Failure with Major Complication or Comorbidity. The data is further fragmented at the DRG group level and for specific DRGs within the group as well, to generate a layered analysis of all claims involved, such as Index hospitalization, rehospitalization, SNFs, HHAs, and Hospice. Reducing the overall MSPB episode cost by targeting specific DRGs with higher averages will improve inpatient care and stabilize financial footing.

Post-discharge costs are the predominant cost contributors per MSPB episode. For the Jan-Dec 2018 period, the post-discharge cost share was $17,251, amounting to 32% of the total share. SNF cost was the highest post-discharge cost contributor at $9,490. For the current time period, Jan-Dec 2019, the post-discharge cost rose to 47% of the total cost, adding $34,774 to the cost per episode. Rehospitalization saw a staggering growth of 332.79% over a 12 month rolling time period to reach at $23,795.