:Implementation of the Affordable Care Act has increased the number of Americans with health insurance. However, a substantial portion of the population is still considered underserved, including those who are uninsured, underinsured, and those who are enrolled in Medicaid. The patients frequently face substantial access-to-care issues. Many underlying social determinants of health impact this vulnerable, underserved population, and surgeons must understand the nuances of caring for the underserved. There are numerous opportunities to engage with this population, and providing care to the indigent can be rewarding for both the vulnerably underserved patient and their surgeon.
Objective: To analyze trends in open and minimally invasive (MIS) sacroiliac joint fusion (SIJF) that coincide with changes in compensation models and Current Procedural Terminology (CPT) codes.
Design: Database analysis
Setting: American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Database
Patients/Participants: Underwent SIJF, based on CPT codes, from 2007-2018
Intervention: Open and MIS SIJF
Main Outcome Measurements: Proportion of open versus MISJ SIJF, proportion of inpatient vs outpatient SIJF, relative value units
Results: There were 744 total SIJFs performed. Open SIJFs totaled 683, while 65 MIS SIJFs were performed. The number of SIJFs increased yearly, apart from two years, with a similar trend noted when controlling for the number of NSQIP entries per year. From 2014-2018, MIS SIJF made up a significantly larger proportion of total SIJFs (p<0.0001) and the proportion of outpatient SIJFs increased over the entire study period (p=0.0002).
Conclusions: SIJF is being increasingly utilized, coinciding with regulatory approval and the American Medical Association’s formal recognition of MIS SIJF. Related changes to coding and compensation serve as a model for the economic processes behind surgical innovation, highlighting the importance of surgeon advocacy along the way.
Level of Evidence: III; Retrospective Cohort Study
Keywords: Sacroiliac joint; arthrodesis; fusion; minimally invasive; NSQIP, economics, compensation, policy
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