Haglin Jack M, Zabat Michelle A, Richter Kent R, McQuivey Kade S, Godzik Jakub, Patel Naresh P, Eltorai Adam E M, Daniels Alan H
1Mayo Clinic School of Medicine, Scottsdale, Arizona.
2Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona.
J Neurosurg Spine. 2022 Mar 25;37(3):452-459. doi: 10.3171/2022.2.SPINE211368. Print 2022 Sep 1.
Procedural reimbursement for spine surgery has changed drastically over the past 20 years. A comprehensive understanding of these trends is important as major changes in reimbursement models of spine surgery continue to evolve within various spine specialties as well as broader national healthcare policy. In this study the authors evaluated the monetary trends in Medicare reimbursement rates for the 15 most common spinal surgery procedures from 2000 to 2021.
The National Surgery Quality Improvement Project database (2019) was queried to determine the 15 most commonly performed spine surgery procedures. The Current Procedural Terminology (CPT) codes for each of these procedures were obtained from the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services, and comprehensive reimbursement data for each code were extracted. Changes in Medicare reimbursement rates were calculated and averaged for each procedure as both raw percent changes and percent changes adjusted for inflation to 2021 US dollars (USD) based on the consumer price index (CPI). The adjusted R2 value, the compound annual growth rate (CAGR), and both the average annual and the total percent change in reimbursement were calculated based on these adjusted trends for all included procedures.
After adjustment for inflation, average reimbursement for all procedures decreased by 33.8% from 2000 to 2021. The greatest mean decrease was seen in anterior cervical arthrodesis (-38.7%), while the smallest mean decrease was in vertebral body excision (-17.1%). From 2000 to 2021, the adjusted reimbursement rate for all included procedures decreased by an average of 1.9% each year, with an average R2 value of 0.69.
This is the first study to evaluate monetary trends in Medicare reimbursement for spine surgery procedures. After adjusting for inflation, Medicare reimbursement for the 15 most commonly performed spine procedures has steadily decreased from 2000 to 2021. Increased awareness of these trends and the forces driving them will be critical in the coming years as negotiations regarding reimbursement models continue to unfold. Greater understanding of spine surgery reimbursement among policy makers, hospitals, and surgeons will be important to ensure continued access to quality surgical spine care in the United States.
在过去20年中，脊柱手术的程序报销发生了巨大变化。随着脊柱手术报销模式在各个脊柱专科以及更广泛的国家医疗政策中持续演变，全面了解这些趋势非常重要。在本研究中，作者评估了2000年至2021年医疗保险对15种最常见脊柱手术程序的报销率的货币趋势。
查询国家手术质量改进项目数据库（2019年）以确定15种最常进行的脊柱手术程序。这些程序各自的现行手术操作术语（CPT）代码从医疗保险和医疗补助服务中心的医师费率表查询工具中获取，并提取每个代码的全面报销数据。计算每种程序医疗保险报销率的变化，并以原始百分比变化和根据消费者价格指数（CPI）调整为2021年美元（USD）的通货膨胀调整后的百分比变化进行平均。基于所有纳入程序的这些调整趋势，计算调整后的R2值、复合年增长率（CAGR）以及报销的年均和总百分比变化。
经通货膨胀调整后，2000年至2021年所有程序的平均报销额下降了33.8%。平均降幅最大的是颈椎前路融合术（-38.7%），而平均降幅最小的是椎体切除术（-17.1%）。从2000年到2021年，所有纳入程序的调整后报销率平均每年下降1.9%，平均R2值为0.69。
这是第一项评估医疗保险对脊柱手术程序报销的货币趋势的研究。经通货膨胀调整后，2000年至2021年医疗保险对15种最常进行的脊柱手术程序的报销稳步下降。随着关于报销模式的谈判不断展开，未来几年提高对这些趋势及其驱动因素的认识将至关重要。政策制定者、医院和外科医生对脊柱手术报销有更深入的了解对于确保美国继续提供高质量的脊柱手术护理至关重要。
