UMMS Affiliation

Department of Surgery, Division of Neurosurgery

Faculty Advisor

Julie G. Pilitsis



Document Type


Medical Subject Headings

Neurosurgical Procedures; Neurosurgery; Universal Coverage; Massachusetts; Hospital Charges


Health and Medical Administration | Life Sciences | Medicine and Health Sciences | Surgery



It has been four years since the introduction of universal health care coverage in Massachusetts. Our initial assessment performed from 2007-2008 demonstrated largely positive results.


We performed a follow-up study to assess the long term financial impact of universal health care on hospital charges associated with neurosurgical operative cases at our institution.


The billing records from July 1, 2009 – June 30, 2010 were compared to those from 2007 and 2008. Records were analyzed for length of stay, case mix, patient age, hospital charge, reimbursement, and procedure.


Case volume increased by 31% and mean acuity increased from 2.3 to 3.1 (p < 0.005). Hospital stays lengthened by 1 day (p < 0.005). Payor mix changed over this time with Commonwealth Care and Medicaid comprising 2.9% and 12.4%, respectively, of neurosurgical inpatients; neither had significantly different acuity or lengths of stay. Despite an increase in case volume by 31% and significantly increased acuity in 2010, revenue increased 14% over early reform data. When volume was normalized, extrapolations of pre-reform and early reform coverage on current financials demonstrated that the change in payor mix alone had decreased revenue by 30% and 24%, respectively. When modifying 2010 financials by considering 2007 reimbursement rates and 2007 payor mix, these changes together resulted in a revenue reduction of 36%.


Taken together, our data suggests that revenue associated with hospital charges for neurosurgical inpatients has decreased significantly since health care reform went into effect.


Medical student Anthony Burrows participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.



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