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Reimbursement Related to a 90-Day Episode of Care for a One or Two-Level Anterior Cervical Discectomy and Fusion

Virk, Sohrab S. MD, MBA; Phillips, Frank M. MD; Khan, Safdar N. MD

Journal of Bone & Joint Surgery - American Volume: 17 August 2016 - Volume 98 - Issue 16 - p 1378–1384
doi: 10.2106/JBJS.15.01169
Scientific Articles

This article was updated on September 7, 2016, because of a previous error. On page 1381, the third column in Table V had read “Reimbursement per Patient*” and now reads “Total Reimbursement per Code*.” Additionally, the footnote for Table V had read “*The values are given as the reimbursement, with the percentage of the total reimbursement in parentheses. The total percentage from the top 5 CPT codes is 15.79%” and now reads “*The values are given as the total reimbursement for each code, with the percentage of the total reimbursement of $69,469,550 in parentheses. The total percentage from the top 5 CPT codes is 15.79%.”

An erratum has been published: J Bone Joint Surg Am. 2016 Oct 19;98(20):e94.

Background: A bundled payment represents a single payment for services during an episode of care for a surgical procedure. Anterior cervical discectomy and fusion (ACDF) and associated 90-day costs have been suggested as a bundle amenable to such a payment structure; however, to our knowledge, there are limited available data with regard to costs related to this procedure and subsequent care.

Methods: The Medicare 5% National Sample Administrative Database was used to catalog clinical and financial data associated with the day of the surgical procedure and the 90-day postoperative period for patients undergoing a one to two-level ACDF procedure from 2005 to 2012. We simultaneously queried the database for total knee replacement as a means to compare the payments and to verify the reliability of our analysis.

Results: A total of 4,506 patients underwent an ACDF procedure for cervical radiculopathy. The total 90-day reimbursement was $69,469,550 or a mean cost per patient (and standard deviation) of $15,417 ± $947 (median, $15,589). As a comparison, the mean reimbursement for patients who had undergone a total knee replacement amounted to $17,451 per patient. The physician reimbursement for ACDF represented 20.42% of the total, with the surgeon receiving 18.07% of the total reimbursement. Revision surgery, readmission, and emergency department reimbursement accounted for 0.71% of the total reimbursement. Reimbursement for rehabilitation services, including physical therapy, skilled nursing facilities, and home care, represented 3.11% of the total reimbursement. There was a significant variation in reimbursement among geographic regions in the United States (p < 0.001), with the highest in the West.

Conclusions: To our knowledge, this study is the first report on 90-day reimbursement per patient for one to two-level ACDF procedures in a Medicare cohort. Payments varied significantly among geographic locations. Our study provides a reimbursement benchmark for one to two-level ACDF procedures. Clarifying the payments relative to costs will help providers to understand whether a bundled payment for the ACDF procedure is economically viable.

1Department of Orthopaedics, Wexner Medical Center at The Ohio State University, Columbus, Ohio

2Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois

E-mail address for S.N. Khan:

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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