title: Understanding the Extent and Drivers of Interphysician Cost Variation for Spine Procedures.
abstract: METHODS
  Retrospective analysis of billing data, medical records, and hospital cost data.
  
  
  OBJECTIVE
  To quantify intersurgeon variation for hospital costs of four spine procedures while adjusting for patient comorbidities and demographic factors.
  
  
  BACKGROUND
  Spine care accounts for $90 billion in health care expenditures in the United States. Past findings demonstrate regional variation in surgery rates and high intersurgeon variation for anterior cervical discectomies/fusions. However, less has been done to examine intersurgeon variation in resource use across multiple procedures while adjusting for patient characteristics outside of a surgeon's control.
  
  
  METHODS
  We examined intersurgeon variation for 1241 elective spine procedures at one facility for 3 years. The procedures included 1 to 2 level cases of anterior cervical discectomies/fusions, posterior lumbar decompressions/fusions, posterior laminectomies, and lumbar discectomies. We isolated mean and median costs by surgeon and adjusted for patient demographics, comorbidities, and procedure types. Finally, we examined variation in subcategories such as instrumentation and inpatient stay costs to determine which contribute to total cost variation.
  
  
  RESULTS
  Unadjusted costs per surgeon varied by a factor of 1.32 to 1.81 between lowest and highest cost surgeon depending on procedure. After adjusting for patient features and procedure, variation was reduced to 1.31x. Of the seven surgeons who had sufficient patient volume, one was significantly less costly (-$1,462 per procedure) whereas three were significantly more costly than mean (+$685, +$839, +$702 per procedure). Intersurgeon differences in supply and operating room costs largely accounted for total variation, though actual drivers of variation were surgeon-specific.
  
  
  CONCLUSIONS
  Surgeons vary in average cost for spine procedures, though variation is more modest once adjusted for patient characteristics. Data on procedure-level variation should be discussed with individual surgeons to shift practice patterns. Finally, the comparison methodology can be applied to other procedures and specialties.
  
  
  METHODS
  4.
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: Alex
authors.initials: A
authors.lastname: Kazberouk
authors.affiliation: Department of Clinical Research Center, Soroka University Medical Center.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Iftach
authors.initials: I
authors.lastname: Sagy
authors.affiliation: Department of Clinical Research Center, Soroka University Medical Center.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.affiliation: Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Kevin
authors.initials: K
authors.lastname: McGuire
mesh_terms: D000328:Adult; D000368:Aged; D032882:Comprehension; D005260:Female; D017048:Health Care Costs / Q000592:standards; D017721:Hospital Costs / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069471:Neurosurgeons / Q000191:economics* / Q000592:standards; D019635:Neurosurgical Procedures / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000191:economics* / Q000601:surgery*