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Presentation #67: Reimbursement and Charges 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

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Spine Journal Meeting Abstracts: 2016 - Volume 2016 - Issue - p 229–230
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Introduction: Bundled payments represent 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, little data regarding costs related to this procedure and subsequent care are available.

Methods: The Medicare 5% national sample administrative database was used to catalog clinical and financial data associated with the day of surgery 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 verify the reliability of our analysis.

Results: A total of 4,506 patients underwent an ACDF procedure for cervical radiculopathy. Total 90‐day reimbursement was $69,469,550 or $15,417 / patient ( + / ‐ $947, median = $15,589). As a comparison, reimbursement for TKR patients amounted to $17,451 / patient. Physician reimbursement for ACDF represented 20.42% of the total with the surgeon receiving 18.07% of total reimbursement. Revision surgery, readmission and emergency department reimbursement accounted for 0.71% of total reimbursement. Reimbursement for rehabilitation service, including physical therapy, skilled nursing facilities and home care represented 3.11% of total reimbursement. There was a statistically significant variation in reimbursement among geographic regions, being highest in the western United States (p = 0.015) [Figure 1], and a trend towards increase in overall reimbursement over the years from 2005 to 2012 (p = 0.082) [Figure 2].

Figure 1
Figure 1:
Figure 1. Breakdown of top DRG and CPT codes by region
Figure 2
Figure 2:
Figure 2. Variation in reimbursement per patient for the years 2005–2012

Conclusions: This study is the first report we are aware of 90‐day reimbursement / patient for oneto two‐level ACDF procedures in a Medicare cohort. Payments had a statistically significant variation among geographic locations. Our study provides a reimbursement benchmark for one‐ to two‐level ACDF procedures and understanding the payments relative to costs will help providers understand whether a bundled payment for the ACDF procedure is economically viable.

© 2016 Lippincott Williams & Wilkins, Inc.