3 years ago

Drivers of Medicare Reimbursement for Thoracolumbar Fusion: An Analysis of Data From The Centers For Medicare and Medicaid Services

Drivers of Medicare Reimbursement for Thoracolumbar Fusion: An Analysis of Data From The Centers For Medicare and Medicaid Services
Padegimas, Eric M., Zmistowski, Benjamin, Khanna, Krishn, Verma, Kushagra, Howley, Michael
Study Design.A retrospective observational study. Objective.The purpose of this study is to examine the variation in thoracolumbar fusion (TLF) payment and determine the drivers of this variation. Summary of Background Data.As health care spending continues to increase, variation in surgical procedures reimbursements has come under more scrutiny. TLF is an example of a high-cost, proven-benefit procedure that is often the focus of Centers for Medicare and Medicaid Services (CMS) administrators. There is a wide variation in TLF charges, but the drivers for this variation are not clear. Methods.Claims for TLF were identified in the CMS data by analyzing Diagnosis Related Group (DRG) number 460 (“Spinal Fusion Except Cervical without Major Complications or Comorbidities”). Data on factors that may impact cost of care were collected from four sources: the United States Census Bureau, CMS, the Dartmouth Atlas, and WWAMI Rural Health Research Center. These were then grouped into seven categories: quality, supply, demand, substitute treatment availability, patient characteristics, competitive factors, and provider characteristics. Predictive reimbursement models were created from the data using multivariate linear regression to understand the factors that influence TLF reimbursement. Results.There was significant geographic variability in reimbursement. The largest contribution to reimbursement variation came from variables in the demand (ΔR2  = 13.4%, P < 0.001), supply (ΔR2  = 9.2%, P < 0.001), and competitive factor domains (ΔR2  = 9.1%, P < 0.001). The top three drivers that increased reimbursement were provider charges (β = 0.37, P < 0.001), total Medicare reimbursement in the region (β = 0.19, P < 0.001), and the number of spinal surgeries per 1000 patients in that region (β = 0.06, P = 0.02). Institutional volume, a surrogate for quality was negatively associated with TLF reimbursement. Conclusion.There was wide variation in reimbursement for TLF across the U.S. The variables that drive TLF reimbursement variation include supply, demand, and competition. Interestingly, quality of care was not associated with increased TLF reimbursement.Level of Evidence: N/A
You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.