Department of Neurosurgery, The Johns Hopkins University School of Medicine, Meyer 7-109 600 N. Wolfe St, Baltimore, MD 21287, USA.
Spine J. 2013 Nov;13(11):1434-7. doi: 10.1016/j.spinee.2013.03.015. Epub 2013 Apr 23.
Spine-related health-care expenditures accounted for $86 billion dollars in 2005, a 65% increase from 1997. However, when adjusting for inflation, surgeons have seen decreased reimbursement rates over the last decade.
To assess contribution of surgeon fees to overall procedure cost, we reviewed the charges and reimbursements for a noninstrumented lumbar laminectomy and compared the amounts reimbursed to the hospital and to the surgeon at a major academic institution.
STUDY DESIGN/SETTING: Retrospective review of costs associated with lumbar laminectomies.
Seventy-seven patients undergoing lumbar laminectomy for spinal stenosis throughout an 18-month period at a single academic medical center were included in this study.
Cost and number of laminectomy levels.
The reimbursement schedule of six academic spine surgeons was collected over 18 months for performed noninstrumented lumbar laminectomy procedures. Bills and collections by the hospital and surgeon professional fees were comparatively analyzed and substratified by number of laminectomy levels and patient insurance status. Unpaired two-sample Student t test was used for analysis of significant differences.
During an 18-month period, patients underwent a lumbar laminectomy involving on average three levels and stayed in the hospital on average 3.5 days. Complications were uncommon (13%). Average professional fee billing for the surgeon was $6,889±$2,882, and collection was $1,848±$1,433 (28% overall, 30% for private insurance, and 23% for Medicare/Medicaid insurance). Average hospital billing for the inpatient hospital stay minus professional fees from the surgeon was $14,766±$7,729, and average collection on such bills was $13,391±$7,256 (92% overall, 91% for private insurance, and 85% for Medicare/Medicaid insurance).
Based on this analysis, the proportion of overall costs allocated to professional fees for a noninstrumented lumbar laminectomy is small, whereas those allocated to hospital costs are far greater. These findings suggest that the current focus on decreasing physician reimbursement as the principal cost saving strategy will lead to minimal reimbursement for surgeons without a substantial drop in the overall cost of procedures performed.
2005 年，与脊柱相关的医疗保健支出达到 860 亿美元，比 1997 年增长了 65%。然而，经通胀调整后，在过去十年中，外科医生的报销率有所下降。
为了评估外科医生费用对整个手术费用的贡献，我们审查了非器械性腰椎板切除术的费用和报销情况，并比较了主要学术机构的医院和外科医生的报销金额。
研究设计/地点：腰椎板切除术相关成本的回顾性研究。
在一家学术医疗中心进行了为期 18 个月的脊柱狭窄症腰椎板切除术的 77 名患者纳入本研究。
成本和腰椎板切除术的数量。
在 18 个月的时间里，收集了六位学术脊柱外科医生的非器械性腰椎板切除术的报销时间表。对医院和外科医生专业费用的账单和收款进行了比较分析，并按腰椎板切除术的数量和患者保险状况进行了细分。未配对的两样本 t 检验用于分析显著差异。
在 18 个月期间，患者平均进行了三次腰椎板切除术，平均住院时间为 3.5 天。并发症并不常见（13%）。外科医生的平均专业费用账单为 6889 美元±2882 美元，实收为 1848 美元±1433 美元（整体 28%，私人保险 30%，医疗保险/医疗补助保险 23%）。医院对住院患者的账单扣除外科医生的专业费用为 14766 美元±7729 美元，实收为 13391 美元±7256 美元（整体 92%，私人保险 91%，医疗保险/医疗补助保险 85%）。
根据这项分析，非器械性腰椎板切除术的总费用中分配给专业费用的比例很小，而分配给医院费用的比例要大得多。这些发现表明，目前将降低医生报销作为主要成本节约策略的重点将导致外科医生的报销金额微不足道，而手术的总体成本不会大幅下降。
