General Session: Value and Outcomes in Spine Surgery

Presented by: N. Anand - View Audio/Video Presentation (Members Only)

Author(s):

P. Nunley(1), R. Fessler(2), P. Park(3), J. Zavatsky(4), G. Mundis(4,5), J. Uribe(6), R. Eastlack(5), D. Chou(7), M. Wang(8), N. Anand(9), A. Kanter(10), C. Shaffrey((1)(1)), P. Mummaneni(7), International Spine Study Group (ISSG)

(1) Spine Institute of Louisiana, Shreveport, LA, United States
(2) Rush University Medical Center, Chicago, IL, United States
(3) University of Michigan, Ann Arbor, MI, United States
(4) San Diego Center for Spinal Disorders, San Diego, CA, United States
(5) Scripps Clinic, La Jolla, CA, United States
(6) University of South Florida, Tampa, FL, United States
(7) University of California at San Francisco, San Francisco, CA, United States
(8) University of Miami, Miami, FL, United States
(9) Cedars Sinai Medical Center, Los Angeles, CA, United States
(10) University of Pittsburgh Medical Center, Pittsburgh, PA, United States
((1) (1) ) University of Virginia Neurological Surgery, Charlottesville, VA, United States

Abstract

Purpose: Medicare DRG based reimbursement is important to the financial stability of hospitals. Hospitals must be able to adequately cover costs in order to continue to offer the best available care for patients, yet the DRG reimbursement is not well understood for minimally invasive spine (MIS) deformity procedures. DRG for participating hospitals were reviewed based on length of stay and medical comorbidities (CC).

Methods: The Inpatient PPS PC Pricer (CMS.gov) was used to collect reimbursement data from 2015 for MIS surgical deformity procedures DRG's at our hospitals. DRG based reimbursement was obtained for MIS anterior, posterior and circumferential 1-level and multi-level fusion for listhesis and deformity cases with and without CC from 12 institutions throughout the US. The 3 most common MIS procedures were analyzed to compare reimbursement based on DRG coding: 1) Anterior OR Posterior ONLY Fusion 2) Anterior Fusion with posterior percutaneous fixation (no dorsal fusion) 3) Combined Anterior AND posterior fixation AND Fusion.

Results: Cases 1,2,3 were reimbursed the same regardless the number of levels fused. Cases 1 and 2 without CC, 3 day stay reimbursed $41,404 vs 8 day reimbursed $42,808. Cases 1 and 2 with CCs, 3 day stay reimbursed $54,476, vs 8 day stay reimbursed $55,881. Case 3 without CC, 3 day stay reimbursed $47,992 vs. 8 day stay reimbursed $49,397. Case 3 with CC, 3 day reimbursed $61,806 vs 8 day reimbursed $63,212. The increased payment for an 8 day stay was $1,405 or $281 per day. If a deformity case 1 or 2 is coded incorrectly as a degenerative case the decrease in payment was $9,769 lower (24% loss) with no CC and $22,841 lower (42% loss) with CC.

Conclusions: Regardless the direct costs, Medicare DRG based reimbursement was the same for single and multi-level MIS deformity cases. The use of posterior percutaneous fixation without dorsal fusion resulted in a 13-16% lower reimbursement compared with addition of a posterior arthrodesis. Improper case coding (degen vs deformity) resulted in 24%-42% lower DRG based reimbursement.