Bundled payment reimbursement for anterior and posterior approaches for cervical spondylotic myelopathy: an analysis of private payer and Medicare databases

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Cervical spondylotic myelopathy (CSM) is a progressive spinal condition that often requires surgery. Studies have shown the clinical equivalency of anterior versus posterior approaches for CSM surgery. The purpose of this study was to determine the amount and type of resources used for anterior and posterior surgical treatment of CSM by using large national databases of clinical and financial information from patients.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This study consists of 2 large cohorts of patients who underwent either an anterior or posterior approach for treatment of CSM. These patients were selected from the Medicare 5% National Sample Administrative Database (SAF5) and the Humana orthopedic database (HORTHO), which is a database of patients with private payer health insurance. The outcome measures were the cost of a 90-day episode of care, as well as a breakdown of the cost components for each surgical procedure between 2005 and 2014.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 16,444 patients were included in this analysis. In HORTHO, there were 10,332 and 1556 patients treated with an anterior or posterior approach for CSM, respectively. In SAF5, there were 3851 and 705 patients who were treated by an anterior or posterior approach for CSM, respectively. The mean ± SD reimbursements for anterior and posterior approaches in the HORTHO database were $20,863 ± $2014 and $23,813 ± $4258, respectively (p = 0.048). The mean ± SD reimbursements for anterior and posterior approaches in the SAF5 database were $18,219 ± $1053 and $25,598 ± $1686, respectively (p &lt; 0.0001). There were also significantly higher reimbursements for a rehabilitation/skilled nursing facility and hospital/inpatient care for patients who underwent a posterior approach in both the private payer and Medicare databases. In all cohorts in this study, the hospital-related reimbursement was more than double the surgeon-related reimbursement.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study provides resource utilization information for a 90-day episode of care for both anterior and posterior approaches for CSM surgery. There is a statistically significant higher resource utilization for patients undergoing the posterior approach for CSM, which is consistent with the literature. Understanding the reimbursement patterns for anterior versus posterior approaches for CSM will help providers design a bundled payment for patients requiring surgery for CSM, and this study suggests that a subset of patients who require the posterior approach for treatment also require greater resources. The data also suggest that hospital-related reimbursement is the major driver of payments.</jats:p></jats:sec>

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

“…23,24,28 Reducing 90-day hospital readmission rates improves patient quality of life, decreases the total cost during the postoperative global period, and avoids penalization from the Medicare Hospital Readmission Reduction Program. 7,9,23,29 In this cohort, ASA score, cervical myelopathy as the indication for surgery, and increased length of surgery were significantly associated with 90-day readmission rates. ASA score had the greatest association for requiring a readmission, and length of surgery although statistically significant had a negligible OR of 1.002.…”

“…[1][2][3][4][5] The total cost of ACDF surgery varies, and spine surgeons are under more pressure to minimize the cost of surgery. [6][7][8][9] In a study investigating variability in the cost of ACDF surgery, the cost of surgery ranged from $26 653 to $129 220. 10 Bundled repayment provides a fixed fee for service for the surgical hospitalization and for the 90-day postoperative period.…”

Impact of Surgical Timing and Approaches to Health Care Utilization in Patients Undergoing Surgery for Acute Traumatic Cervical Spinal Cord Injury

“…We also performed a multivariable analysis for each outcome using linear regression on log-transformed values for continuous outcomes and logistic regression for categorical outcomes. In these models, we included all patient characteristics (gender, age, Elixhauser index and insurance type [19]) in addition to the fusion approach. From these models, we built a linear contrast to compare different groups to the reference group.…”

Recent advances in the management of cervical spondylotic myelopathy: bibliometric analysis and surgical perspectives

“…38 The main purpose of surgery is usually to decompress the spinal cord while stabilizing the affected segments, and sometimes to prevent or cease progression of kyphotic deformity in the future. 1,15,64 Spinal cord decompression can be performed via anterior, posterior, or combined approaches, which has been a classic topic of debate in spine surgery. Anterior surgery has included discectomy and corpectomy with or without instrumentation, whereas posterior options have included laminoplasty and laminectomy with or without instrumentation.…”