312 - Medicare DRG Reimbursement Differences for MIS deformity Surgery in Ac...

#312 Medicare DRG Reimbursement Differences for MIS deformity Surgery in Academic vs Private Hospitals in Different GeographicRegions

Value and Outcomes in Spine Surgery

Poster Presented by: P. Nunley


P. Nunley (1)
G. Mundis (2,3)
R. Fessler (4)
P. Park (5)
J. Zavatsky (2)
J. Uribe (6)
R. Eastlack (3)
D. Chou (7)
M. Wang (8)
N. Anand (9)
A. Kanter ( (1)0)
C. Shaffrey ( (1) (1))
P. Mummaneni (7)
International Spine Study Group (ISSG)

(1) Spine Institute of Louisiana, Shreveport, LA, United States
(2) San Diego Center for Spinal Disorders, San Diego, CA, United States
(3) Scripps Clinic, La Jolla, CA, United States
(4) Rush University Medical Center, Chicago, IL, United States
(5) University of Michigan, Ann Arbor, MI, 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
((1) 0) University of Pittsburgh Medical Center, Pittsburgh, PA, United States
((1) (1) ) University of Virginia Neurological Surgery, Charlottesville, VA, United States


Purpose: Medicare DRG based reimbursement is different based on surgery type, length of stay, and medical comorbidities (CC). Additionally, the geographic location (urban vs suburban) and institution type (private vs academic) also affect the amount of Medicare DRG reimbursement. Here, we investigate the variations in Medicare DRG based reimbursement based on academic vs private hospitals, urban vs suburban, length of stay, and medical comorbidities (CC) for MIS deformity procedures.

Methods: MIS deformity reimbursement DRG's were assessed at our study group hospitals using the PPS PC Pricer (CMS.gov) for 2015. Anterior, posterior and circumferential 1 level and multi-level listhesis and deformity DRG based reimbursement at 12 institutions was collected. Three surgical case types with and without CC were evaluated at academic and private hospitals in both urban and suburban areas:

Results: (Table 1) All cases had the same Medicare DRG reimbursement regardless the number of levels fused. Academic reimbursement was significantly higher than private, 54% (range: 50%-61%) (p values 0.013-0.025.) Urban reimbursement was 25% (range: 23%-27%) higher than suburban. (Table 2) A hospital stay of 8 days vs 3 days increased reimbursement by $355/day for academic and $61/day for private.

Conclusion: Medicare DRG based reimbursement was highest for urban academic institutions. Private suburban hospitals should be efficient to offset the reimbursement reduction. The number of levels fused and the length of hospital stay has minimal impact on DRG based reimbursement regardless of costs.

Table 1