Oral Posters: Values and Outcomes in Spine Surgery

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

Author(s):

N. Jain(1), S. Virk(1), F. Phillips(2), S. Khan(1)

(1) Ohio State University, Orthopaedics, Columbus, OH, United States
(2) Rush University Medical Center, Orthopaedics, Chicago, IL, United States

Abstract

Introduction: Episode based bundling is likely to soon become the major form of reimbursement for many elective spine procedures. The average surgery cost varies with the type of procedure, hospital, patient comorbidities, complications, and post-discharge cost (revisions and readmissions). Therefore, assigning a uniform bundle amount will first require extensive scrutinizing of existing reimbursement data to give an estimate of previous payments, their distribution, and sources of variation, if any. This information is not known for a lumbar discectomy, which is the most common elective spine procedure done in the outpatient setting. In this context, we analyze the reimbursement data over the years from Commercial payers and Medicare for a primary single level lumbar discectomy/decompression and simulate a 90-day payment bundle for the same.

Methods: Administrative claims data was used to study reimbursements from Commercial payers (2007-Q2 2015), Medicare Advantage (2007-Q2 2015), and Medicare (2005-2012) for a primary single level lumbar discectomy/decompression. Distribution of payments among various service providers was studied and a 90-day bundle was simulated. In addition to descriptive analysis, variation between regions and payers was studied by a one way analysis of variance (ANOVA) and post-hoc Tukey test, as appropriate.

Results: Average facility (Hospital/Ambulatory Surgery Center) costs constituted 59.7 % to 73.6 % of total payments, followed by surgeon's fees which accounted for 13.7 to 18.5 %. Post-acute services such as outpatient visits and investigations (4.2 to 7.5%), injections (0.4 to 1.3%), skilled nursing care (0.1 to 1.7%), and readmissions (3.2 t to 6.3%) made up the remaining share of the total reimbursement. The national 90-day bundle amount was estimated at $11,091, $6,571 and $6,239 for Commercial payers, Medicare Advantage and Medicare, respectively. Overall, service providers in the Southern region were reimbursed the lowest from Commercial payers and Medicare, compared to other regions. Surgeries performed in the Inpatient/Hospital setting were significantly more expensive as compared to surgeries performed in the Outpatient/Ambulatory Surgery Center (ASC) setting (p< 0.01).

Conclusion: Facility costs constitute the maximum share and variation in reimbursements for a primary single level lumbar discectomy. Surgeries done in the Inpatient/Hospital setup are costlier than when done in the Outpatient/ASC setting. Commercial payers reimburse almost double the amount of what Medicare does for a single level lumbar discectomy. There is regional variation in reimbursements for major clinical services, however not uniform.