Sohrab S Virk1, Frank M Phillips2, Safdar N Khan3. 1. Department of Orthopaedics, Wexner Medical Center at The Ohio State University, Columbus, Ohio. 2. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois. 3. Department of Orthopaedics, Wexner Medical Center at The Ohio State University, Columbus, Ohio safdar.khan@osumc.edu.
Abstract
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.
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.
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