Search Results

You are looking at 1 - 10 of 51 items for :

  • "Medicare reimbursement" x
Clear All
Free access

Joshua M. Rosenow and Katie O. Orrico

F ederally funded health insurance programs such as Medicare are increasingly at the center of the health system reform debate. With an annual budget of over $500 billion, Medicare controls a significant amount of the more than $2.5 trillion spent annually on health care in the United States. 3 Moreover, decisions made by the Centers for Medicare and Medicaid Services (CMS) regarding what services to cover and how much to reimburse for these services set the tone for many private insurers as well. The amount budgeted for Medicare reimbursement for

Restricted access

Jack M. Haglin, Kent R. Richter and Naresh P. Patel

. Analyzing and understanding these trends, and how reimbursement has changed over time in neurosurgery, is necessary to ensure the continued growth and success of neurosurgery in the United States. Considering the importance of such data and their currently undefined nature, this study looks to evaluate monetary trends in Medicare reimbursement rates in neurosurgery from 2000 to 2018. Methods Utilizing the most recent data from the American College of Surgeons’ National Surgical Quality Improvement Project database, the top 10 most commonly billed CPT codes in both cranial

Restricted access

Ann R. Stroink and Katie O. Orrico

P hysician reimbursement in the United States is largely determined by Medicare as the single largest and most dominant healthcare payer. Medicaid and private insurers utilize Medicare reimbursement data and are influenced by Medicare policies and decisions to implement their own fee schedules, thus expanding the ramifications of any changes made by the Centers for Medicare & Medicaid Services (CMS) to the Medicare Physician Fee Schedule. Fully understanding patterns in physician compensation remains challenging in a precarious healthcare environment plagued by

Free access

Matthew D. Alvin, Jacob A. Miller, Daniel Lubelski, Benjamin P. Rosenbaum, Kalil G. Abdullah, Robert G. Whitmore, Edward C. Benzel and Thomas E. Mroz

registry database at Tufts Medical Center Institute for Clinical Research and Health Policy—which uses the MEDLINE search engine to collect and screen studies to determine if the study has an original cost-utility estimate—and the MEDLINE search engine itself. The former is a comprehensive database of all health-related cost-effectiveness studies published from 1976 to the present. Both the CEA registry database and MEDLINE search engine were queried with the following keywords: “cost effectiveness,” “spine surgery costs,” “Medicare reimbursement,” “cost utility analyses

Free access

Stacey J. Ackerman, David W. Polly Jr., Tyler Knight, Tim Holt and John Cummings Jr.

published economic studies to date that analyze the cost of nonoperative care for SI joint pain in a Medicare population, we evaluated the medical resource use and Medicare reimbursement for patients managed nonoperatively for degenerative sacroiliitis/SI joint disruption in a Medicare population. Methods Study Design and Data Sources Medical resource use and associated Medicare reimbursement for patients with degenerative sacroiliitis/SI joint disruption were examined retrospectively for Medicare beneficiaries for a 5-year period per patient within the dates

Free access

Praveen V. Mummaneni, Robert G. Whitmore, Jill N. Curran, John E. Ziewacz, Rishi Wadhwa, Christopher I. Shaffrey, Anthony L. Asher, Robert F. Heary, Joseph S. Cheng, R. John Hurlbert, Andrea F. Douglas, Justin S. Smith, Neil R. Malhotra, Stephen J. Dante, Subu N. Magge, Michael G. Kaiser, Khalid M. Abbed, Daniel K. Resnick and Zoher Ghogawala

, 31 Direct costs from a societal perspective for lumbar discectomy and single-level fusion were estimated using 2011 Medicare reimbursement values for current procedural terminology (CPT) codes and diagnosis-related group (DRG) codes ( Table 1 ) ( ). 6 , 7 , 36 Indirect costs were estimated using the human capital method; that is, the amount of missed work multiplied by the US national wage index from 2011 ( ). 17 The cost of complications from lumbar

Free access

Nataniel H. Lester-Coll, Arie P. Dosoretz, William J. Magnuson, Maxwell S. Laurans, Veronica L. Chiang and James B. Yu

randomized trial on SRS or SRS+WBRT for 1 to 3 brain metastases determined the ICER for SRS versus SRS+WBRT to be $41,783 per QALY gained. 15 A retrospective by Hall et al. reviewed the records of 289 patients treated with SRS or SRS+WBRT to determine both survival outcomes and Medicare reimbursement for all treatments incurred and found that SRS was the most cost-effective option. 13 However, only 14% of patients in this study treated with SRS alone had more than 4 brain metastases. Our study has limitations. While our model was primarily informed by data from the JLGK

Restricted access

Sheeraz A. Qureshi, Steven McAnany, Vadim Goz, Steven M. Koehler and Andrew C. Hecht

(professional fees not included) was obtained by multiplying hospital charges by the hospital-specific cost-to-charge ratio provided by the NIS. Specific costs associated with physician services for each surgical procedure were determined from the mean Medicare reimbursement data for 2010. All costs in this study are denominated in 2010 dollars ( Table 2 ). TABLE 2: Costs of procedures used in the decision model, based on 2010 Medicare data and NIS data for DRG and CPT codes Procedure DRG CPT Code Cost Name Code Cost CDR

Full access

Sherman C. Stein, Neil R. Malhotra and Mark G. Burnett

to follow-up costs, such as costs of medications, rehabilitation, and emergency room and office visits. Medicare reimbursement rates involve bundling for certain combined procedures. For example, this would result in reimbursement for ACDF at far below the $3775.82 quoted by authors. CDR devices are quite expensive, costing hospitals approximately $4500 to $6000 per device. This amount is not reimbursed by Medicare and appears nowhere in the authors' calculations. Granted, using Medicare reimbursement as a proxy for medical costs is common. However, in this

Free access

Christopher I. Shaffrey and Justin S. Smith

therapeutic interventions used for the evaluation and treatment of SI joint conditions has exploded. The number of SI joint interventions increased from 46,940 in 2000 to 231,800 in 2008, an increase of nearly 500%. 7 “Nonoperative care to manage sacroiliac joint disruption and degenerative sacroiliitis: high costs and medical resource utilization in the United States Medicare population” by Ackerman and colleagues is a retrospective study that explores medical resource use and associated Medicare reimbursement for patients managed with nonoperative care for degenerative