Does certificate-of-need status impact lumbar microdecompression reimbursement and utilization? A retrospective database review

Abstract

Background: Lumbar microdecompression remains an effective, highly utilized procedure. Changes in reimbursement and practice patterns have pushed for decreased costs and increased outpatient surgery. Certificate of Need (CON) programs were established in response to skyrocketing healthcare costs, although their impact on spine surgery utilization and reimbursement is not well studied. This study sought to examine the effect of CON status on utilization and reimbursement of single-level lumbar microdecompressions in both inpatient and outpatient settings. Methods: We analyzed a combined private payer and Medicare administrative claims dataset from 2007 to 2015. All single-level lumbar microdecompressions were divided into CON and non-CON states. We further split each group into inpatient and outpatient. Reimbursement and utilization trends were analyzed using the compound annual growth rate (CAGR). Reimbursement trends were inflation-adjusted by using the US Bureau of Labor Statistics Consumer Price Index (CPI). Results: A total of 58,497 single-level lumbar decompressions were identified, with 42,595 performed in the inpatient setting and 15,902 in the outpatient setting. Utilization rates increased across all settings, but the highest growth was seen in the outpatient setting for CON states (CAGR 32.2%), with the lowest growth seen in the inpatient setting in non-CON states (12.9%). Reimbursement decreased in the inpatient setting (−4.9% CON, −4.3% non-CON), although it increased in both outpatient settings (4.4% CON, 3.4% non-CON). Non-CON outpatient had the highest average reimbursement at $2915, while non-CON inpatient reimbursement was the lowest at $812. Conclusions: Lumbar decompression utilization is increasing, but reimbursement in the inpatient setting is decreasing regardless of CON status. Both are increasing in the outpatient setting. CON states had higher utilization increases than non-CON states. There was no correlation with CON status and overall reimbursement. Surgeons should be aware of these trends in a value-based healthcare environment. Level of Evidence: Level III.