Introduction Some hospitals do not have the technological capabilities of obtaining full 36-inch long-standing films to evaluate patients via proper sagittal balance spinal imaging protocol. Resistance from hospital administration for the purchase of proper hardware and software remains frustrating for spinal surgeons at both community and academic hospitals. Materials and methods Recurring transaction-based revenue streams were applied comparing cost with the different income generation at the hospital level. Cost is fixed cost, attributed to purchasing both the physical radiograph machine as well as the necessary software capabilities. Marginal cost was negligible as both materials and human capital are largely fungible and trivial at the margin. Revenue generation is largely identical to marginal revenue. Income was linked to the Hospital Outpatient Prospective Payment System for radiographic interpretation of films (Current Procedural Terminology (CPT) 72069). Income was also estimated from surgical volume calculation. Results The listed prospective outpatient radiographic reimbursement for the hospital was $24.36 per film. Medicare-defined reimbursements for a complex spinal fusion except cervical with spinal curvature, malignancy or 9+ fusions with a Major Complication or Comorbidity (MCC) was listed at $55,228, and with a Complication or Comorbidity (CC) was noted to be $40,566. Complex spinal fusion except cervical with spinal curvature, malignancy or 9+ fusions without CC/MCC was listed as $30,913. Lumbar spinal fusion except cervical with MCC was $39,164 and with CC was $23,490. University Neurosurgery at Louisiana State University (LSU) Health Sciences Center in Shreveport, LA performed 1,013 thoracolumbar procedures in fiscal year (FY) 2015 with 557 (54.9%) being instrumented procedures. At a minimum, all instrumented procedures could benefit from proper spinal axis imaging, representing $13,568.52 of transaction-based annual gross revenue from radiographs alone. Hypothetical revenue generation of $491,696.42 was calculated. Conclusion There is a significant value proposition to the hospital in obtaining the proper technology for formal standing 36-inch scoliosis imaging. Marginal cost is negligible, while there are significant opportunities for marginal revenue per image obtained through transaction-based gross revenue, as well an immense hypothetical revenue stream from surgery-related gains. More importantly, it ensures a proper and complete delivery of spinal health to the hospital's healthcare population.
Keywords: 36 inch standing films; radiographs; spinal deformity; value proposition.