LAUSR

Study Design: A retrospective cohort study was performed for patients undergoing 1–2-level lumbar fusion (1–2LF) from 2005 to 2014 using an administrative claims database. Objective: The objective of this study was to determine changes in: (1) annual charges; (2) annual reimbursement rates; and (3) annual difference (charges minus reimbursements) in patients undergoing 1–2LF. Summary of Background Data: With implementation of value-based care in orthopaedics, coupled with the rise in number of patients undergoing 1–2LF, understanding the discordance in hospital charges and reimbursements is needed. The difference in hospital charges to reimbursements specifically for 1–2LF for degenerative disc disease has not been studied. Materials and Methods: A Medicare administrative claims database was queried for patients undergoing primary lumbar fusion using ICD-9 procedural code 81.04–81.08. Patients specifically undergoing 1–2LF were filtered from this cohort using ICD-9 procedural code 81.62. The query yielded 547,067 patients who underwent primary 1–2LF. Primary outcomes analyzed included trends in charges, reimbursement rates, and net difference in cost over time and per annual basis. Linear regression evaluated the change in costs over time with a P-value less than 0.05 considered significant. Results: From 2005 to 2014, total charges increased from $6,085,838,407 to $19,621,979,956 and total reimbursements increased from $1,677,764,831 to $4,656,702,685 (all P<0.001). Per patient charges increased 92.10% from 2005 to 2014 for patients undergoing primary 1–2LF from $129,992 to $249,697 (P<0.001). Similarly, an increase in reimbursement per patient of 65.35% from $35,836 to $59,258 (P<0.001) was noted. The annual difference in charges to reimbursements increased 102.26% during the study interval from $94,155 to $190,439 (P<0.001). Conclusions: Per patient charges and reimbursements both increased over the study period; however, charges increased 30% more than reimbursements. Further breakdown of hospital, surgeon, and anesthesiologist reimbursements for 1–2LF is needed. Level of Evidence: Level III.