90-day posterior lumbar fusion payments: 74.2% to 77% go to hospitals — 5 things to know

Written by Laura Dyrda | January 12, 2018 | Print  |

A new study published in Spine examines the 90-day reimbursements for primary single-level posterior lumbar fusion.


Study authors examined administrative claims data for commercial payers, Medicare Advantage and Medicare plans for primary single-level posterior lumbar interbody fusions. The authors also found how payments were distributed among stakeholders.


The study authors found:


1. Hospital costs accounted for 74.2 percent to 77 percent of the total payments for single-level posterior lumbar fusions. Surgeons' fees accounted for 12.8 percent to 13.7 percent.


2. Readmissions and revisions accounted for 2.1 percent to 2.7 percent of the overall burden; however, among those patients who were readmitted, the readmissions and revisions cost 25 percent to 54 percent of the payment for the 90-day episode.


3. Inpatient surgery facility costs were significantly higher than outpatient surgery facility costs.


4. For commercial payers, the average 90-day payment was $51,465, compared with $26,234 for Medicare Advantage and $25,501 for Medicare.


5. Study authors concluded that reducing hospital costs and readmissions could lower financial burden from spine procedures.


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