Over 20 years of declining Medicare reimbursement for spine surgeons: a temporal and geographic analysis from 2000 to 2021

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  • 1 Mayo Clinic School of Medicine, Scottsdale, Arizona;
  • | 2 Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona;
  • | 3 Department of Neurosurgery Mayo Clinic, Phoenix, Arizona;
  • | 4 Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
  • | 5 Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
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OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

ABBREVIATIONS

APM = alternative payment model; CAGR = compound annual growth rate; CMS = Centers for Medicare and Medicaid Services; CPI = consumer price index; CPT = Current Procedural Terminology; GPCI = geographic practice cost index; MACRA = Medicare Access and Children’s Health Insurance Program Reauthorization Act; RVU = relative value unit; SGR = Sustainable Growth Rate; USD = US dollars.

Spine - 1 year subscription bundle (Individuals Only)

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JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

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