P66. An analysis of Medicare reimbursement rates in spine surgery: 2000-2018

Abstract

BACKGROUND CONTEXT Considering fluctuating policy, variance in proposed payment models, and the presence of ever-rising health care costs, there is noted financial uncertainty regarding health care in the US. Despite this, there has been relatively few studies regarding reimbursement models and trends in reimbursement rates. A comprehensive understanding of such trends is important as continued progress is made to advance agreeable reimbursement models in spine surgery. PURPOSE The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for the 15 most common spinal surgery procedures from 2000 to 2018. STUDY DESIGN/SETTING Analysis of a publicly-available, government-compiled reimbursement database. OUTCOME MEASURES Annual reimbursement rates across 15 commonly performed spine surgery procedures. METHODS The National Surgery Quality Improvement Project (NSQIP) database (2016) was queried to determine the 15 most performed spine surgery procedures. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for each of the top 15 most utilized CPT codes in spine surgery, and reimbursement data was extracted. All monetary data was adjusted for inflation to 2018 US dollars (USD) utilizing changes to the consumer price index (CPI). The R-squared and both average annual and the total percentage change in reimbursement were calculated based on these adjusted trends for all included procedures. RESULTS After adjusting for inflation, the average physician reimbursement for all procedures decreased by 25.8% from 2000 to 2018. The greatest mean decrease was seen in anterior cervical arthrodesis (-32.1%), while the smallest mean decrease was in vertebral body excision (-13.3%). From 2000 to 2018, the adjusted reimbursement rate for all included procedures decreased by an average of 1.7% each year, with an average R-squared value of 0.69. CONCLUSIONS This is the first study to evaluate trends in procedural Medicare reimbursement for spine surgery. When adjusted for inflation, Medicare reimbursement for included procedures has steadily decreased from 2000 to 2018. Increased awareness and consideration of these trends will be important for policy-makers, hospitals, and surgeons in order to assure continued access to meaningful surgical spine care in the United States. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.