A new study published in The Spine Journal examines bundled payments among Medicare beneficiaries for cervical fusions.
The study authors examined data on 5 percent of the national sample of Medicare claims filed from 2008 to 2014. The study authors included just patients who survived 90 days after surgery that had full data for the postoperative period. There were 12,419 cervical fusions included in the study.
Researchers found:
1. The average reimbursement for cervical fusions by diagnosis related groups are as follows:
• Cervical fusion with major complication or comorbidity: $54,314
• Cervical fusion with comorbidity and complications: $28,535
• Cervical fusion without major comorbidity or complications: $18,492
2. The 90-day reimbursement adjusted for risks for patients with no comorbidities and underwent one to three level fusion was $13,924 for women and $15,846 for men. The reimbursement increased $1,007 for women and $2,431 for men between the ages of 70 and 84 years old.
3. Patients who underwent upper cervical surgery reported $1,678 lower costs while patients who had posterior approach procedures added $3,164 to the reimbursement on average. The patients who had more than three levels fused reported $2,561 higher reimbursement and interbody devices increased the reimbursement of procedure by $667.
4. Neuromonitoring was also associated with increased reimbursement of around $1,018 and those undergoing cervical fusions for a fracture reported $3,530 higher reimbursement on average.
5. The severe comorbidities associated with increased reimbursement included:
• Malnutrition: $15,536
• CVA/stroke: $6,982
• Drug abuse or dependence: $5,059
• Hyper coagulopathy: $5,436
• Chronic kidney disease: $4,925
"Our findings suggest that defining payments based on DRG codes only is an imperfect way of employing bundled payments for spinal fusions and will only end up creating major financial disincentives and barriers to access of care in the healthcare system," concluded the study authors.