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

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In Spine

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