Medicare payment data for spine reimbursement; important but flawed data for evaluating utilization of resources

Abstract

Background:Medicare data showing physician-specific reimbursement for 2012 were recently made public in the mainstream media. Given the ongoing interest in containing healthcare costs, we analyze these data in the context of the delivery of spinal surgery.Methods:Demographics of 206 leading surgeons were extracted including state, geographic area, residency training program, fellowship training, and academic affiliation. Using current procedural terminology (CPT) codes, information was evaluated regarding the number of lumbar laminectomies, lumbar fusions, add-on laminectomy levels, and anterior cervical fusions reimbursed by Medicare in 2012.Results:In 2012 Medicare reimbursed the average neurosurgeon slightly more than an orthopedic surgeon for all procedures ($142,075 vs. $110,920), but this was not found to be statistically significant (P = 0.218). Orthopedic surgeons had a statistical trend illustrating increased reimbursement for lumbar fusions specifically, $1187 versus $1073 (P = 0.07). Fellowship trained spinal surgeons also, on average, received more from Medicare ($125,407 vs. $76,551), but again this was not statistically significant (P = 0.112). A surgeon in private practice, on average, was reimbursed $137,495 while their academic counterparts were reimbursed $103,144 (P = 0.127). Surgeons performing cervical fusions in the Centers for Disease Control West Region did receive statistically significantly less reimbursement for that procedure then those surgeons in other parts of the country (P = 0.015). Surgeons in the West were reimbursed on average $849 for CPT code 22,551 while those in the Midwest received $1475 per procedure.Conclusion:Medicare reimbursement data are fundamentally flawed in determining healthcare expenditure as it shows a bias toward delivery of care in specific patient demographics. However, neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data as it will affect healthcare reimbursement and delivery moving forward.

Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review

“…[ 1 22 27 31 37 ] In addition, not only were the costs for fusions 2.6 fold greater than those for laminectomy alone, but physician reimbursement rates were also higher with fusions (e.g., TLIF/MI TLIF/PLIF/others average $142,075/year). [ 25 42 ] Here, we predomiantly reviewed the literature regarding complication and reoperation rates for performing laminectomy alone vs. MI TLIF. In particular, we asked whether for comparable degenerative lumbar disease/DS, whether the added morbidity of MI TLIF fusion was and is acceptable.…”

“…Several studies documented the increased frequency, costs, and reimbursement rates for instrumented fusion vs. lumbar laminectomy alone addressing degenerative lumbar disease with/without DS. [ 5 25 42 ] Utilizing the Nationwide Inpatient Sample (NIS) plus US Census/other data, Bernstein et al . (2017) determined that from 2003 to 2012 the number of lumbar diskectomies decreased by 19.8% and laminectomies by 26.1%, while there was an increase of 56.4% in the incidence of lumbar spinal fusions.…”

“…(2015), evaluating Medicare data from 2012, found that for 206 spinal surgeons performing lumbar laminectomies (including add-on levels)/fusions), the average neurosurgeon was paid $142,075 for all procedures. [ 25 ] In 2017, Zygourakis et al . (2017), utilizing the 2001 to 2013 National Inpatient Sample database, evaluated the different costs for performing discectomy/laminectomy (181,267 patients) vs. instrumented lumbar fusions (433,364 patients) in different locations in the US.…”

View of U.S. spine surgeons regarding cost reduction measures

“…The increasing cost of healthcare in the United States (US), approximately $2.8 trillion or 18% of the GDP, has produced a debate regarding how to curtail spending while still providing high-quality care (1). Because physicians play a critical role in influencing healthcare costs, their views are of particular importance.…”

We Need to Talk about Lumbar Total Disc Replacement

“…In spite of a growing body of subsequent studies that indicate that several of the exclusion criteria of the original IDE trial should not be deemed contraindications to LTDR, many health insurance companies nevertheless inappropriately adopted these trial-specific exclusion criteria as eligibility criteria for financial support for LTDR, and they continue to do so (again, with adverse consequences for demand by patients for the procedure and its uptake by surgeons). 510 Finally, the regulatory demands on surgeons and paramedical and nursing staff are exacting, and, in a litigious environment, medicolegal considerations discourage personnel from conducting a procedure that might not fulfill all eligibility criteria (even nonclinical criteria and irrespective of the perceived [in]appropriateness of such criteria 675 ). 676 The problems are best exemplified by the hypothetical surgeon who wants to introduce this noninferior and cost-effective procedure to his/her practice.…”