Excess Charges in Intracranial Meningioma Surgery: The Influence of Patient and Hospital Characteristics

Background Current Affordable Care Act (ACA) legislation places an emphasis on determining factors that contribute to hospital-based charges as they relate to total patient care costs. Knowledge of excess hospital-based admission charges related to the surgical management of intracranial meningiomas may provide insight into factors associated with increased healthcare charges. We compare charges for patients admitted for resection of meningiomas in New York State to identify socioeconomic and hospital characteristics associated with excess charges.

Methods Records pertaining to intracranial meningiomas in New York State from 1995 to 2015 were obtained from Statewide Planning and Research Cooperative System (SPARCS) database. The primary outcome of interest was excess charges (76–100th percentile of charges) for the surgical admission. Multivariate logistic regression analysis was performed to assess patient and hospital characteristics on inpatient hospital charges.

Results A total of 14,239 patients underwent meningioma resection. Socioeconomic characteristics associated with increased charges included African American (OR = 1.53, 95% CI: 1.31–1.79, p < 0.001) and Asian (OR = 1.42, 95% CI: 1.10–1.82, p = 0.007) race. Increased charges were associated with higher Charlson Comorbidity Index (CCI) scores (p < 0.05), obesity (OR = 2.31, 95% CI: 1.88–2.84, p < 0.001), tobacco use (OR = 1.75, 95% CI: 1.41–2.16, p < 0.001), cerebral edema (OR = 3.42, 95% CI: 2.97–3.94, p < 0.001), and brain compression (OR: 2.43, 95% CI: 1.95–3.02, p < 0.001). Female gender (OR = 0.80, 95% CI: 0.72–0.89, p < 0.001), living in rural areas (OR = 0.66, 95% CI: 0.52–0.83, p < 0.001), decreasing income (p < 0.05), and Medicaid (OR = 0.66, 95% CI: 0.54–0.79, p < 0.001), or Medicare (OR = 0.71, 95% CI: 0.61–0.82, p < 0.001) insurance status were associated with lower charges. Hospital characteristics associated with increased charges included high-volume centers (OR: 3.95, 95% CI: 3.04–5.13, p < 0.001) and hospitals located in New York City (OR = 1.59, 95% CI: 1.42–1.77, p < 0.001). Teaching status (OR = 0.73, 95% CI: 0.55–0.96, p = 0.023) was associated with decreased charges. Median charges at high-volume centers ($60,412.18, n = 10,252) were greater than medium-volume ($50,180.27, n = 3294) or low-volume ($50,170.79, n = 693) centers (p < 0.001).

Conclusion Hospital charges for meningioma surgery are affected by numerous patient and medical center characteristics. Hospital factors associated with statistically significant higher charges include high-volume surgical centers and New York City location. Patient-specific factors associated with higher charges are African American race, Asian race, obesity, higher CCI scores, tobacco use, and presenting radiographic findings (cerebral edema, brain compression). There may be a need to allocate appropriate resources to high-volume centers that treat complex medically morbid patients. There are likely specific populations at-risk who may require earlier identification and intervention to optimize outcomes. A more comprehensive understanding of the socioeconomic drivers of charges is necessary to better implement current ACA guidelines.

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