Mills Emily S, Mayfield Cory K, Shelby Tara, Ton Andy T, Hah Raymond J, Alluri Ram K
Keck School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
Keck School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.
Int J Spine Surg. 2023 Apr;17(2):222-229. doi: 10.14444/8428. Epub 2023 Mar 21.
Cervical disc arthroplasty (CDA) was originally approved by the US Food and Drug Administration (FDA) in 2007 as a motion-sparing procedure to treat cervical degenerative disc disease. Since then, promising results from randomized control trials have led to increasing popularity. However, data discussing monetary trends are limited. The aim of this study was to determine how utilization, hospital charges, and Medicare physician reimbursement for CDA have changed over time.
In this retrospective cohort study, International Classification of Diseases procedure codes were used to identify all patients who underwent CDA from 2007 to 2017 in the National Inpatient Sample database. The Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services was queried for primary CDA using current procedural terminology codes to determine Medicare physician reimbursement from 2009 to 2021. Nominal monetary values were adjusted for inflation using the Consumer Price Index and inflation-adjusted data reported in 2021 US dollars.
A total of 33,079 weighted patients who underwent CDA were included for analysis. CDA utilization increased by 183% from 2007 to 2017, with Medicare beneficiary utilization increasing 149%. Inflation-adjusted total hospital charges for CDA increased by 22.4%. However, inflation-adjusted Medicare physician reimbursement fell by 1.20% per year, demonstrating a total decrease of 12.9%, starting at $1928 in 2009 and declining to $1679 in 2021.
While utilization and total hospital charges for CDA continue to rise, Medicare physician reimbursement has not shown the same trend. In fact, inflation-adjusted reimbursement has seen a steady decline since FDA approval in 2007. If this trend persists, it may become unsustainable for physicians to continue offering CDA to Medicare patients. As disproportionate increases in hospital charges incentivize a transition to outpatient CDA, stricter patient selection criteria associated with outpatient procedures may create health care disparities for Medicare patients and those with higher comorbidity burden.
This study shows the decreasing reimbursement trends for CDA, which may disproportionately affect Medicare patients and those with increased comorbidities.
颈椎间盘置换术（CDA）最初于2007年获得美国食品药品监督管理局（FDA）批准，作为一种保留运动功能的手术用于治疗颈椎退行性椎间盘疾病。从那时起，随机对照试验的良好结果使其越来越受欢迎。然而，关于费用趋势的数据有限。本研究的目的是确定CDA的使用情况、医院收费以及医疗保险医师报销费用随时间的变化情况。
在这项回顾性队列研究中，使用国际疾病分类手术编码在国家住院样本数据库中识别2007年至2017年期间所有接受CDA的患者。使用当前手术术语编码查询医疗保险和医疗补助服务中心的医师费用表查询工具，以确定2009年至2021年的原发性CDA医疗保险医师报销费用。使用消费者价格指数对名义货币价值进行通货膨胀调整，并以2021年美元报告通货膨胀调整后的数据。
总共纳入33079例接受CDA的加权患者进行分析。从2007年到2017年，CDA的使用量增加了183%，医疗保险受益人的使用量增加了149%。CDA的通货膨胀调整后总医院收费增加了22.4%。然而，通货膨胀调整后的医疗保险医师报销费用每年下降1.20%，从2009年的1928美元开始，到2021年降至1679美元，总计下降了12.9%。
虽然CDA的使用量和总医院收费持续上升，但医疗保险医师报销费用并未呈现相同趋势。事实上，自2007年FDA批准以来，通货膨胀调整后的报销费用一直在稳步下降。如果这种趋势持续下去，医生继续为医疗保险患者提供CDA可能变得不可持续。由于医院收费的不成比例增加促使向门诊CDA过渡，与门诊手术相关的更严格患者选择标准可能会给医疗保险患者和合并症负担较高的患者造成医疗保健差异。
本研究显示了CDA报销费用下降的趋势，这可能对医疗保险患者和合并症增加的患者产生不成比例的影响。
