Association of Medicare and Medicaid Insurance Status with Increased Spine Surgery Utilization Rates

Benton, Joshua; Weiss, Brandon; Mowrey, Wenzhu; Yassari, Neeky; Wang, Benjamin; Ramos, Rafael De la Garza; Gelfand, Yaroslav; Castro-Rivas, Erida; Puthenpura, Vidya; Yassari, Reza; Yanamadala, Vijay

doi:10.1097/brs.0000000000003968

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…Recent research has focused on socioeconomic status (SES) and potential healthcare disparities [ 8 , 9 ]. The correlation between an individual’s SES, treatment options, and PROs is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Lawlor,

Rubery,

Thirukumaran

et al. 2024

Cureus

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Objective To explore how socioeconomic status and patient characteristics may be associated with initial self-reports of pain and determine if there was an increased association with undergoing spine surgery. Methods Patients at an academic center between 2015 and 2021 who completed the Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) questionnaire were included. Multivariable linear regression models were used to determine the association between insurance type and patient factors with initial reports of pain. Multivariable logistic regression models were used to determine the association between PI and the likelihood of surgery in two time periods, three and 12 months. Results The study included 9,587 patients. The mean PROMIS-PI scores were 61.93 (SD 7.82) and 63.74 (SD 6.93) in the cervical and lumbar cohorts, respectively. Medicaid and Workers’ Compensation insurance patients reported higher pain scores compared to those with private insurance: Medicaid (cervical: 2.77, CI (1.76-3.79), p<0.001; lumbar (2.05, CI (1.52-2.59), p<0.001); Workers’ Compensation (cervical: 2.12, CI (0.96-3.27), p<0.001; lumbar: 1.51, CI (0.79-2.23), p<0.001). Black patients reported higher pain compared to White patients (cervical: 1.50, CI (0.44-2.55), p=0.01; lumbar: 1.51, CI (0.94-2.08), p<0.001). Higher PROMIS-PI scores were associated with a higher likelihood of surgery. There was no increased association of likelihood of surgery in Black, Medicaid, or Workers’ Compensation patients when controlling for pain severity. Conclusion Black patients and patients with Medicaid and Workers’ compensation insurance were likely to report higher pain scores. Higher initial pain scores were associated with an increased likelihood of surgery. However, despite increased pain scores, Black patients and those with Medicaid and Workers’ Compensation insurance did not have a higher likelihood of undergoing surgery.

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Section: Introductionmentioning

confidence: 99%

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Lawlor,

Rubery,

Thirukumaran

et al. 2024

Cureus

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“…Consequently, there has been a debate regarding the therapeutic decision for DCM ( 11 ). In addition, the surgical indications can be slightly different depending on the surgeon's practice style, preference, and health insurance system ( 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Classification of expert-level therapeutic decisions for degenerative cervical myelopathy using ensemble machine learning algorithms

Park

Cho²,

Yang³

et al. 2022

Front. Surg.

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BackgroundTherapeutic decisions for degenerative cervical myelopathy (DCM) are complex and should consider various factors. We aimed to develop machine learning (ML) models for classifying expert-level therapeutic decisions in patients with DCM.MethodsThis retrospective cross-sectional study included patients diagnosed with DCM, and the diagnosis of DCM was confirmed clinically and radiologically. The target outcomes were defined as conservative treatment, anterior surgical approaches (ASA), and posterior surgical approaches (PSA). We performed the following classifications using ML algorithms: multiclass, one-versus-rest, and one-versus-one. Two ensemble ML algorithms were used: random forest (RF) and extreme gradient boosting (XGB). The area under the receiver operating characteristic curve (AUC-ROC) was the primary metric. We also identified the variable importance for each classification.ResultsIn total, 304 patients were included (109 conservative, 66 ASA, 125 PSA, and 4 combined surgeries). For multiclass classification, the AUC-ROC of RF and XGB models were 0.91 and 0.92, respectively. In addition, ML models showed AUC-ROC values of >0.9 for all types of binary classifications. Variable importance analysis revealed that the modified Japanese Orthopaedic Association score and central motor conduction time were the two most important variables for distinguishing between conservative and surgical treatments. When classifying ASA and PSA, the number of involved levels, age, and body mass index were important contributing factors.ConclusionML-based classification of DCM therapeutic options is valid and feasible. This study can be a basis for establishing generalizable ML-based surgical decision models for DCM. Further studies are needed with a large multicenter database.

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“…16,17 Interestingly, patients with Medicare are more likely to be recommended for surgery despite limited research examining Medicare as a predictor of clinical outcomes. 18 Patient-reported outcome measures (PROMs) assess patients' physical and mental function, quality of life, and pain both preoperatively and postoperatively, and they are increasingly utilized in spine literature to evaluate clinical outcomes. 19,20 Many non-disease-related factors have been associated with outcomes following lumbar spine surgery, such as depression, workers compensation status, and smoking status.…”

mentioning

confidence: 99%

“…Overall, Medicare patients have similar access to care as commercial insurance patients, although previous literature demonstrates that senior surgeons are less likely to accept patients with Medicare 16,17. Interestingly, patients with Medicare are more likely to be recommended for surgery despite limited research examining Medicare as a predictor of clinical outcomes 18…”

mentioning

confidence: 99%

Does Age Younger Than 65 Affect Clinical Outcomes in Medicare Patients Undergoing Lumbar Fusion?

Karamian

Toci²,

Lambrechts³

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Study Design: This was a retrospective cohort study. Objective: To determine if age (younger than 65) and Medicare status affect patient outcomes following lumbar fusion. Summary of Background Data: Medicare is a common spine surgery insurance provider, but most qualifying patients are older than age 65. There is a paucity of literature investigating clinical outcomes for Medicare patients under the age of 65. Materials and Methods: Patients 40 years and older who underwent lumbar fusion surgery between 2014 and 2019 were queried from electronic medical records. Patients with >2 levels fused, >3 levels decompressed, incomplete patient-reported outcome measures (PROMs), revision procedures, and tumor/infection diagnosis were excluded. Patients were placed into 4 groups based on Medicare status and age: no Medicare under 65 years (NM<65), no Medicare 65 years or older (NM≥65), yes Medicare under 65 (YM<65), and yes Medicare 65 years or older (YM≥65). T tests and χ2 tests analyzed univariate comparisons depending on continuous or categorical type. Multivariate regression for ∆PROMs controlled for confounders. Alpha was set at 0.05. Results: Of the 1097 patients, 567 were NM<65 (51.7%), 133 were NM≥65 (12.1%), 42 were YM<65 (3.8%), and 355 were YM≥65 (32.4%). The YM<65 group had significantly worse preoperative Visual Analog Scale back (P=0.01) and preoperative and postoperative Oswestry Disability Index (ODI), Short-Form 12 Mental Component Score (MCS-12), and Physical Component Score (PCS-12). However, on regression analysis, there were no significant differences in ∆PROMs for YM <65 compared with YM≥65, and NM<65. NM<65 (compared with YM<65) was an independent predictor of decreased improvement in ∆ODI following surgery (β=12.61, P=0.007); however, overall the ODI was still lower in the NM<65 compared with the YM<65. Conclusion: Medicare patients younger than 65 years undergoing lumbar fusion had significantly worse preoperative and postoperative PROMs. The perioperative improvement in outcomes was similar between groups with the exception of ∆ODI, which demonstrated greater improvement in Medicare patients younger than 65 compared with non-Medicare patients younger than 65. Level of evidence: Level III (treatment).

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Association of Medicare and Medicaid Insurance Status with Increased Spine Surgery Utilization Rates

Cited by 7 publications

References 17 publications

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Classification of expert-level therapeutic decisions for degenerative cervical myelopathy using ensemble machine learning algorithms

Does Age Younger Than 65 Affect Clinical Outcomes in Medicare Patients Undergoing Lumbar Fusion?

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