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Nancy McLaughlin, Neil A. Martin, Pooja Upadhyaya, Ausaf A. Bari, Farzad Buxey, Marilene B. Wang, Anthony P. Heaney and Marvin Bergsneider

O ne of the provisions of the Affordable Care Act (ACA) is a new payment paradigm that prioritizes reimbursement on the basis of “value” rather than the current fee-for-service model. In a recent survey, 82% of health plans considered the development of new payment models a “major priority” for their organization. 8 The physician value-based payment modifier was created to provide for differential payment to a physician or group of physicians on the basis of the quality of care delivered and the cost to deliver this care. 4 , 23 The Centers for Medicare

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Nancy McLaughlin, Michael A. Burke, Nisheeta P. Setlur, Douglas R. Niedzwiecki, Alan L. Kaplan, Christopher Saigal, Aman Mahajan, Neil A. Martin and Robert S. Kaplan

overarching goal, they have been far less engaged in cost measurement and containment. Nuanced perceptions of providers' responsibility to reduce cost, a lack of knowledge of health economics, and the absence of accurate and actionable cost data available at the provider level have contributed to the disappointing lack of progress in cost-measurement and cost-reduction initiatives. 8 , 9 , 32 Policy makers refer to “cost” as the payments made to health care providers for delivering care. For providers, however, cost refers to the amounts they pay for personnel, equipment

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J. Paul Elliott, Peter D. Le Roux, Galen Ransom, David W. Newell, M. Sean Grady and H. Richard Winn

outcome-based measures remains important. 29 In addition, economic concerns require a concomitant improvement in methods for assessing and predicting management cost. Length of hospital stay (LOS) provides a reasonable estimate of medical resource utilization and has been emphasized in several recent publications primarily related to cardiac 3, 15 and peripheral vascular surgery. 1, 22 The relationship between LOS and neurosurgical procedures such as lumbar laminectomy 16 and carotid endarterectomy 4 has received attention recently. In the present study we tested

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R. Lorie Jacob, Jonah Geddes, Shirley McCartney and Kim J. Burchiel

D eep brain stimulation (DBS) has been clearly demonstrated to be more effective than best medical therapy for patients with medically intractable Parkinson’s disease. 5 , 19 While high-quality clinical outcomes are important, the value of a procedure is also inversely related to cost. Studies of the cost of DBS for Parkinson’s disease, and other disease entities, have been performed with increasing frequency over the past decade. 1 , 6 − 8 , 13 , 16 A number of studies have been published recently that suggest that DBS is cost-effective after the first

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Benjamin D. Kuhns, Daniel Lubelski, Matthew D. Alvin, Jason S. Taub, Matthew J. McGirt, Edward C. Benzel and Thomas E. Mroz

, additional imaging and laboratory tests, and culture-directed parenteral antibiotic therapy. 2 , 15 The dorsal surgical approach to the cervical spine has a 4.5%–9% postoperative infection rate compared with a 0%–1% rate associated with a ventral approach. 3 , 7 , 17 , 21 Whereas preoperative risk factors for postoperative cervical infections (including smoking, diabetes, and intraoperative blood loss) have been investigated, few studies have assessed the quality of life (QOL) and hospital costs associated with these infections. 24 , 33 Quantifying cost and QOL

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Brice A. Kessler, Michael P. Catalino, Carolyn Quinsey, William Goodnight and Scott Elton

M yelomeningocele (MMC) is characterized by protrusion of neural elements through an unfused portion of the spinal column in utero. 1 , 10 While the incidence of MMC has decreased in the United States in part due to folic acid supplementation, 19 the lifetime care of patients born with MMC remains costly. The cost of care estimates for patients with MMC are 13 times greater in childhood and 3–6 times costlier in adulthood than for individuals without MMC. 6 , 13 This cost is driven by the lifelong clinical sequelae of MMC including hydrocephalus, bowel and

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Nancy McLaughlin, Pooja Upadhyaya, Farzad Buxey and Neil A. Martin

H ealth care expenditures in the US continue to rise annually, faster than the national income. In 2010, health spending exceeded 17% of the nation's gross domestic product. 23 , 29 Numerous elements of national health reform are aimed at cost containment. Importantly, “bending the cost curve” refers most commonly to the government or insurers' payment to providers. However, reducing reimbursements does not decrease the cost of care delivery. The critical issue is how to deliver improved outcomes at the lowest cost and achieve the highest value of care

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Jeff Ehresman, Zach Pennington, Andrew Schilling, Ravi Medikonda, Sakibul Huq, Kevin R. Merkel, A. Karim Ahmed, Ethan Cottrill, Daniel Lubelski, Erick M. Westbroek, Salia Farrokh, Steven M. Frank and Daniel M. Sciubba

O f patients who undergo elective lumbar spine surgery annually in the United States, 1 approximately 17% of patients 2 will require allogeneic blood transfusion. Prior research has found allogeneic transfusion to be associated with higher complication rates, 2 , 3 , 33 including increases in the rates of surgical site infections, 4 thromboembolic events, 5 and kidney injuries. 6 Additionally, the use of allogeneic blood products is associated with significant increases in cost, reported to average between $526 per patient for anterior lumbar cases and

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Ema Zubovic, Jodi B. Lapidus, Gary B. Skolnick, Sybill D. Naidoo, Matthew D. Smyth and Kamlesh B. Patel

familiarity with the treating cranial orthotist, as well as the patient’s distance from our center. Patients meet with the orthotist every 2–3 weeks until the age of 6 months, then monthly until completion of helmet therapy. Multiple helmets may be required, and each new helmet incurs a charge, but there is no additional cost associated with orthotist visits for helmet adjustments. Most patients use a local orthotist, and we have implemented a telemedicine system for patients residing long distances from our center to reduce travel burden. Orthotic measurements are sent to

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Ema Zubovic, Jodi B. Lapidus, Gary B. Skolnick, Sybill D. Naidoo, Matthew D. Smyth and Kamlesh B. Patel

familiarity with the treating cranial orthotist, as well as the patient’s distance from our center. Patients meet with the orthotist every 2–3 weeks until the age of 6 months, then monthly until completion of helmet therapy. Multiple helmets may be required, and each new helmet incurs a charge, but there is no additional cost associated with orthotist visits for helmet adjustments. Most patients use a local orthotist, and we have implemented a telemedicine system for patients residing long distances from our center to reduce travel burden. Orthotic measurements are sent to