Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Abstract

Background Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. Questions/purposes (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? Methods Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) were identified. Patients were divided into two groups based on whether the surgery was performed in the fee-forservice setting (beneficiaries receive care at a civilian facility with expenses covered by TRICARE insurance) or at a Department of Defense facility (direct care). There were 28,344 patients in the entire study, 21,290 treated in fee-for-service and 7054 treated in Department of Defense facilities. Differences in the rates of fusion-based procedures, discectomy, and decompression between both healthcare settings were assessed using multinomial logistic regression to adjust for differences in case-mix and surgical indication. Results TRICARE beneficiaries treated for lumbar spinal disorders in the fee-for-service setting had higher odds of receiving interbody fusions (fee-for-service Conclusions The preferential use of interbody fusion procedures was higher in the fee-for-service setting irrespective of the underlying diagnosis. These results speak to the existence of provider inducement within the field of spine surgery. This reality portends poor performance for surgical practices and hospitals in Accountable CareThis study was supported in part by a grant from the Henry M. Jackson Foundation of the Department of Defense (AHH). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at

Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: a nationwide matched cohort study with a 10-year follow-up

“…21,[24][25][26][27][28][29][30][43][44][45][46][47][48] Recently, claim data have not only been used for accounting but also been used to improve the management of spinal disease. 9,10,20,22,34,[42][43][44][45][49][50][51][52][53][54] National population-based data can be utilized to accomplish goals, such as determining the change in the number of surgical cases, average cost for treatment, use of resources and factors in uencing cost. 32,54,55 For example, Martin et al used claim data to indicate a potential overuse of spinal fusion surgery amid a similar reoperation rate and increased surgical cost.…”

“…[1][2][3][4][5][6][7][8] Many countries have been trying to provide optimal medical services to their residents, but there is also an issue of how to utilize limited resources, especially in regard to a budget. 9,10 Ideally, from the perspective of the society, we need to understand how the budget is currently being used. 10 A National Health Insurance System (NHIS) is one tool that the government can use to take responsibility in providing medical services to the general population while balancing the e cient use of resources.…”

Editorial: The Sacredness of Surgery

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Use of low-value pediatric services in the Military Health System

“…TRICARE is the MHS insurance product, which provides universal coverage to approximately 9.4 million members. TRIC ARE beneficiaries include 20% active-duty military personnel and 80% retirees or family members, and are likely representative of the U.S. population under age 65 [13][14][15][16]. TRICARE does not include care delivered in combat zones, or through Veterans Affairs (VA) hospitals which are part of a separately administered system.…”