1391. Hospital Medicare Reimbursement Rates for Inpatient Episodes of Care in Spine Surgery

Authors: Jack Michael Haglin; Jack Haglin, BS; Jakub Godzik, MD; Kent Richter, BS; Naresh Patel, MD; Alan Daniels, MD; Luis Tumialan, MD (Scottsdale, AZ)


There is a current interest regarding episodic-based reimbursement in spine surgery. As such, the purpose of this study was to evaluate Medicare reimbursement to hospitals for the 3 most common admission types related to spine surgery from 2011 to 2016.


The Inpatient Utilization and Payment Public Use File from the Centers for Medicare & Medicaid Services was queried. The file includes data for three Diagnostic Related Group (DRG) codes related to spine surgery; each was included for study. Codes included DRG 470 for cervical spinal fusion, DRG 460 for non-cervical fusion, and DRG 552 for medical back admission. All data was adjusted for inflation to 2016 US dollars and averaged. The mean percent of the submitted cost covered by Medicare and the total percentage change for each variable throughout the study period were calculated. A student’s t-test was utilized to compare variables with p<.05 indicating significance.  


The mean adjusted Medicare payment for non-cervical fusion decreased by 6.9% (p<.001), remained stable for cervical fusion, and increased by 3.4% (p<.001) for medical back admissions throughout the study. For all DRGs, the mean cost submitted by the hospital increased by 14.2% throughout the study period (p<.001). Meanwhile, the mean amount paid by Medicare across all DRGs decreased by 4.2% (p=.009), while the mean percentage of the total cost of admission covered by Medicare decreased by 3.5% (p<.001) 


This is the first study to evaluate trends in Medicare inpatient reimbursement in spine surgery. For included admissions, the average amount paid by Medicare to hospitals decreased, and Medicare reimbursed a decreasing percentage of total submitted costs throughout the study period. Consideration of these findings will be important for policy-makers, hospitals, and surgeons as continued progress is made to advance agreeable reimbursement models in spine surgery.