• Michael A Mooney, Seungwon Yoon, Tyler Cole, John P Sheehy, Michael A Bohl, F David Barranco, Peter Nakaji, Andrew S Little, and Michael T Lawton.
• Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.
• Neurosurgery. 2019 Jun 1; 84 (6): 1280-1289.

BackgroundPatient out-of-pocket (OOP) spending is an increasingly discussed topic; however, there is minimal data available on the patient financial burden of surgical procedures.ObjectiveTo analyze hospital and surgeon expected payment data and patient OOP spending in neurosurgery.MethodsThis is a retrospective cohort study of neurosurgical patients at a tertiary-referral center from 2013 to 2016. Expected payments, reflecting negotiated costs-of-care, as well as actual patient OOP payments for hospital care and surgeon professional fees were analyzed. A 4-tiered model of patient OOP cost sharing and a multivariate model of patient expected payments were created.ResultsA total of 13 673 consecutive neurosurgical cases were analyzed. Patient age, insurance type, case category, severity of illness, length of stay (LOS), and elective case status were significant predictors of increased expected payments (P < .05). Craniotomy ($53 397 ± 811) and posterior spinal fusion ($48 329 ± 864) were associated with the highest expected payments. In a model of patient OOP cost sharing, nearly all neurosurgical procedures exceeded yearly OOP maximums for Healthcare Marketplace plans. Mean patient payments for hospital care and surgeon professional fees were the highest for anterior/lateral spinal fusion cases for commercially insured patients ($1662 ± 165). Mean expected payments and mean patient payments for commercially insured patients increased significantly from 2013 to 2016 (P < .05).ConclusionExpected payments and patient OOP spending for commercially insured patients significantly increased from 2013 to 2016, representing increased healthcare costs and patient cost sharing in an evolving healthcare environment. Patients and providers can consider this information prior to surgery to better anticipate the individual financial burden for neurosurgical care.Copyright © 2018 by the Congress of Neurological Surgeons.

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