Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.
Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY.
Spine (Phila Pa 1976). 2018 Aug 1;43(15):1074-1079. doi: 10.1097/BRS.0000000000002516.
Retrospective cohort study.
To identify trends in spinal procedure reimbursement in our practice since 2010.
In an uncertain healthcare climate with continuous reform, trends in physician reimbursement are unclear. Market forces of supply and demand, legislation imposing penalties for quality measures, local competition, and geographic location have the potential to affect reimbursement. An emphasis on quality-of-care and cost reduction is placed on providers and insurers. In a high-cost area such as spine surgery, it is unknown what the reimbursement trends have been over the last 7 years of major healthcare reforms.
We collected payments received data for the 20 most commonly billed Current Procedural Terminology (CPT) codes for spinal surgery from January 2010 to December 2016. Payments were adjusted for inflation using the Consumer Price Index for Medical Care in the Northeastern United States. Insurers were separated into four groups: Medicare, Medicaid, Private Insurance, and Workers Compensation and No Fault (WC/NF). Using a weighted average to adjust for variation in procedures performed, average payments were trended over time. Average payments were trended by insurance group averaged by CPT code.
After adjusting for inflation, average overall payments for spinal claims from 2010 to 2016 increased 13.6%. Average reimbursement declined 1.9% from 2010 to 2013 and rose 16.8% from 2014 to 2016. Average Medicaid payments increased 150.1% since 2010 whereas average Medicare payments rose 4.9%. Average reimbursement from private insurers and WC/NF claims decreased 16.2% and 8.5%, respectively, from 2010 to 2013; increasing 14.2% and 12.5%, respectively, from 2014 to 2016. From 2010 to 2016, reimbursement for private insurance decreased 9.3% and increased 8.2% for WC/NF claims.
Since 2010, inflation-adjusted reimbursement for spinal procedures increased in our practice. There was a decline from 2010 to 2013. Increases occurred from 2014 to 2016 across all insurers. Medicaid payments more than doubled since 2010.
回顾性队列研究。
自 2010 年以来，确定我们实践中脊柱手术报销的趋势。
在不确定的医疗保健环境中，不断进行改革，医生报销的趋势尚不清楚。供求的市场力量、对质量措施进行处罚的立法、当地竞争和地理位置都有可能影响报销。提供者和保险公司都强调医疗质量和成本降低。在像脊柱手术这样高成本的领域，过去 7 年的重大医疗改革中，报销趋势如何尚不清楚。
我们收集了 2010 年 1 月至 2016 年 12 月期间最常开具的 20 个当前程序术语 (CPT) 代码的支付数据。使用美国东北部医疗保健消费者价格指数对支付数据进行了通胀调整。保险公司分为四类：医疗保险、医疗补助、私人保险和工人赔偿及无过错保险 (WC/NF)。通过加权平均值调整手术操作的差异，对随时间推移的平均支付进行趋势分析。根据 CPT 代码，按保险组平均对平均支付进行趋势分析。
经通胀调整后，2010 年至 2016 年脊柱索赔的总体平均支付增长了 13.6%。2010 年至 2013 年，平均报销额下降 1.9%，2014 年至 2016 年上升 16.8%。自 2010 年以来，平均医疗补助支付增长了 150.1%，而平均医疗保险支付增长了 4.9%。2010 年至 2013 年，私人保险公司和 WC/NF 理赔的平均报销分别下降 16.2%和 8.5%；从 2014 年到 2016 年，分别增长了 14.2%和 12.5%。2010 年至 2016 年，私人保险的报销下降了 9.3%，而 WC/NF 理赔的报销增加了 8.2%。
自 2010 年以来，我们实践中脊柱手术的通胀调整后报销增加。2010 年至 2013 年有所下降。2014 年至 2016 年，所有保险公司的报销均有所增加。自 2010 年以来，医疗补助支付增加了一倍以上。
3 级。
