MSPB Costs for Spine Surgeries show wide disparities among Hospitals in the New York Tri-State Area


In Spine

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By: Yosh Thomas  Oct. 27, 2020

Dexur analyzed Medicare Claims data to calculate the Medicare Spending per Beneficiary (MSPB) cost for hospitals in the New York tri-state area for Spine surgery and found a wide disparity among hospitals in each sub-area such as Manhattan, Long Island, New Jersey, and Connecticut. MSPB is 25% of the weighting for the CMS Value-Based Purchasing (VBP) programs. Hospitals have to wait about 12-18 months to get aggregate MSPB numbers with no insight into DRG or service line specific costs. Dexur updates DRG and service line MSPB costs by replicating the CMS algorithm on a quarterly basis and only a 5-6 month delay. For the analysis, Dexur considered hospitals in the New York tri-state area that had recorded more than 11 episodes of DRG 460 during the calendar year 2019. Dexur did the analysis based on Q1 2020 data but the Index Hospitalization discharge date was till December 2019 to accommodate the 30-day post-discharge period in calculating rehospitalization, SNF, and HHA costs. The analysis was risk-adjusted and was done for DRG 460: Spinal Fusion Except Cervical Without Major Complication or Comorbidity (MCC).

Manhattan, NY - Spine Surgeries Hospital MSPB Cost Ranking
Rank Hospital City County Episodes Avg. MSPB Cost Per Episode Avg. Index Hospitalization Cost Per Episode Avg. Post Discharge Cost Per Episode Avg. Rehospitalization Cost per Episode Avg. SNF Cost per Episode Avg. HHA Cost per Episode
1 Hospital for Special Surgery New York New York 159 $39,696 $35,703 $3,992 $1,248 $1,537 $1,204
2 New York-Presbyterian Hospital/ Weill Cornell Medical Center New York New York 65 $48,532 $41,334 $7,198 $4,636 $1,760 $797
3 Lenox Hill Hospital New York New York 57 $48,582 $39,686 $8,896 $2,430 $5,666 $799
4 NewYork-Presbyterian/Columbia University Medical Center New York New York 32 $51,086 $42,562 $8,524 $5,423 $1,778 $1,322
5 Mount Sinai Hospital New York New York 75 $58,318 $43,432 $14,874 $6,293 $6,910 $1,670
6 NYU Langone’s Tisch Hospital New York New York 72 $58,882 $49,178 $9,703 $4,198 $3,576 $1,928
7 Mount Sinai West New York New York 16 $60,588 $43,059 $17,529 $11,229 $4,463 $1,815

The analysis revealed that Hospital for Special Surgery had the lowest average MSPB cost per episode in Manhattan, NY, with $39,696. It was followed by NewYork Presbyterian/Weill Cornell Medical Center with an average MSPB cost per episode of $48,532 and an average post-discharge cost per episode of $7,198. On the other hand, Mount Sinai West had the highest average MSPB cost per episode in Manhattan with $60,588. The hospital’s average post-discharge cost per episode was $17,529. The rehospitalization cost was the major contributor to post-discharge costs with the average cost per episode being $11,229. Similarly, NYU Langone's Tisch Hospital and Mount Sinai Hospital also had high average MSPB costs per episode with $58,882 and $58,318, respectively.

Long Island, NY - Spine Surgeries Hospital MSPB Cost Ranking
Rank Hospital City County Episodes Avg. MSPB Cost Per Episode Avg. Index Hospitalization Cost Per Episode Avg. Post Discharge Cost Per Episode Avg. Rehospitalization Cost per Episode Avg. SNF Cost per Episode Avg. HHA Cost per Episode
1 Huntington Hospital Huntington Suffolk 24 $40,206 $31,122 $9,084 $4,640 $4,116 $304
2 St. Francis Hospital Roslyn Roslyn Nassau 34 $40,569 $29,927 $10,642 $1,773 $7,319 $1,549
3 Good Samaritan Hospital Medical Center West Islip Suffolk 19 $43,514 $31,498 $12,015 $7,386 $2,484 $2,144
4 John T. Mather Memorial Hospital of Port Jefferson Port Jefferson Suffolk 39 $44,040 $36,153 $7,881 $2,125 $4,490 $1,266
5 Peconic Bay Medical Center Riverhead Suffolk 21 $44,203 $34,350 $9,853 $1,687 $6,154 $2,012
6 St. Catherine of Siena Hospital Smithtown Suffolk 17 $44,392 $29,838 $14,553 $4,869 $8,252 $1,431
7 Long Island Jewish Valley Stream Valley Stream Nassau 18 $45,576 $38,023 $7,553 $4,069 $2,268 $1,215
8 Long Island Jewish Medical Center New Hyde Park Nassau 27 $47,413 $39,478 $7,934 $1,299 $5,394 $1,241
9 North Shore University Hospital Manhasset Nassau 63 $51,837 $39,216 $12,605 $2,999 $8,277 $1,285
10 Long Island Community Hospital Patchogue Suffolk 11 $52,905 $32,222 $20,683 $4,176 $16,011 $495
11 NYU Winthrop Hospital Mineola Nassau 39 $55,452 $48,414 $7,037 $3,238 $1,894 $1,905
12 University Hospital at Stony Brook Stony Brook Suffolk 45 $56,939 $43,151 $13,788 $7,776 $4,638 $1,373


Dexur considered Nassau and Suffolk counties in Long Island and the corresponding hospitals that met the prerequisite for the study. The analysis revealed that
Huntington Hospital, located in Suffolk County, had the lowest average MSPB cost per episode for DRG 460 with $40,206. It was followed by St. Francis Hospital, Roslyn and Good Samaritan Hospital Medical Center with average MSPB costs of $40,569 and $43,514, respectively. On the other hand, University Hospital at Stony Brook had the highest average MSPB cost per episode with $56,939. The hospital’s average post-discharge cost per episode was $13,788. Rehospitalization cost was the major contributing factor with the average per episode being $7,776, followed by SNF costs and HHA costs with an average of $4,638 and $1,373, respectively, per episode.

New Jersey - Spine Surgeries Hospital MSPB Cost Ranking
Rank Hospital City County Episodes Avg. MSPB Cost Per Episode Avg. Index Hospitalization Cost Per Episode Avg. Post Discharge Cost Per Episode Avg. Rehospitalization Cost per Episode Avg. SNF Cost per Episode Avg. HHA Cost per Episode
1 Holy Name Medical Center Teaneck Bergen 17 $33,871 $29,517 $4,354 $1,320 $2,046 $968
2 Valley Hospital Ridgewood Bergen 26 $35,238 $28,832 $6,406 $1,629 $3,646 $1,126
3 Penn Medicine Princeton Health Plainsboro Middlesex 36 $36,283 $32,018 $4,264 $2,450 $1,103 $710
4 Overlook Medical Center Summit Union 22 $38,345 $32,790 $5,554 $4,369 $799 $386
5 Robert Wood Johnson University Hospital New Brunswick Middlesex 44 $42,172 $36,027 $6,144 $3,681 $1,774 $689
6 Englewood Health Englewood Bergen 26 $42,955 $36,357 $6,597 $1,647 $3,508 $1,441
7 St. Joseph's University Medical Center Paterson Passaic 16 $46,407 $35,684 $10,722 $7,314 $2,286 $1,122
8 Hackensack University Medical Center Hackensack Bergen 38 $47,630 $34,718 $12,911 $8,060 $3,516 $1,335
9 Saint Barnabas Medical Center Livingston Essex 28 $52,996 $35,264 $17,732 $11,174 $4,671 $1,886

Dexur’s latest analysis found that Saint Barnabas Medical Center, located in Essex county, had the highest average MSPB cost per episode with $52,996. The Index MSPB cost accounted for 66% of the overall MSPB cost at an average of $35,264 while the average post-discharge cost per episode was $17,732.  Hackensack University Medical Center, located in Bergen county, also had a high average MSPB cost per episode of $47,630. Contrastingly, Holy Name Medical Center, located in the same county has the lowest average MSPB cost per episode with $33,871. The two hospitals had a difference of $8,557 in the average post-discharge cost per episode.

Connecticut - Spine Surgeries Hospital MSPB Cost Ranking
Rank Hospital City County Episodes Avg. MSPB Cost Per Episode Avg. Index Hospitalization Cost Per Episode Avg. Post Discharge Cost Per Episode Avg. Rehospitalization Cost per Episode Avg. SNF Cost per Episode Avg. HHA Cost per Episode
1 Stamford Hospital Stamford Fairfield 13 $33,817 $31,405 $2,411 NA $497 $1,914
2 MidState Medical Center Meriden New Haven 47 $34,610 $30,133 $4,476 $1,664 $1,607 $1,202
3 Norwalk Hospital Norwalk Fairfield 24 $39,290 $32,494 $6,796 $1,903 $3,379 $1,514
4 Danbury Hospital Danbury Fairfield 75 $40,018 $32,223 $7,794 $2,997 $3,063 $1,733
5 St. Vincent's Medical Center Bridgeport Fairfield 19 $40,550 $33,213 $7,337 $2,598 $2,743 $1,994
6 Bridgeport Hospital Bridgeport Fairfield 16 $42,443 $34,738 $7,704 $1,558 $2,862 $3,282
7 Greenwich Hospital Greenwich Fairfield 19 $43,158 $35,466 $7,692 $2,869 $2,806 $2,016
8 Yale New Haven Hospital New Haven New Haven 60 $58,116 $39,660 $18,429 $8,996 $6,745 $2,687

Fairfield and New Haven were the only two counties in Connecticut that were considered for the study. Yale New Haven Hospital, located in New Haven county, had the highest average MSPB cost at $58,116 in the region. This was attributed to the high post-discharge costs with the average per episode being $18,429. Dexur’s analysis revealed that rehospitalization contributed about 15% of MSPB costs with the average rehospitalization cost being $8,996. The cost of Skilled Nursing Facility (SNF) and Home Health Agency (HHA) contributed to 11% and 3% of MSPB costs, respectively, at an average cost of $6,745 and $2,687 per episode. The only other hospital in the county that met the prerequisites for the study, MidState Medical Center, had a low average MSPB cost per episode with $33,881. Similarly, Stamford Hospital and Norwalk Hospital, located in Fairfield County, had lower average MSPB costs per episode with $33,817 and $39,290, respectively.