title: Reimbursement Related to a 90-Day Episode of Care for a One or Two-Level Anterior Cervical Discectomy and Fusion.
abstract: BACKGROUND
  A bundled payment represents a single payment for services during an episode of care for a surgical procedure. Anterior cervical discectomy and fusion (ACDF) and associated 90-day costs have been suggested as a bundle amenable to such a payment structure; however, to our knowledge, there are limited available data with regard to costs related to this procedure and subsequent care.
  
  
  METHODS
  The Medicare 5% National Sample Administrative Database was used to catalog clinical and financial data associated with the day of the surgical procedure and the 90-day postoperative period for patients undergoing a one to two-level ACDF procedure from 2005 to 2012. We simultaneously queried the database for total knee replacement as a means to compare the payments and to verify the reliability of our analysis.
  
  
  RESULTS
  A total of 4,506 patients underwent an ACDF procedure for cervical radiculopathy. The total 90-day reimbursement was $69,469,550 or a mean cost per patient (and standard deviation) of $15,417 ± $947 (median, $15,589). As a comparison, the mean reimbursement for patients who had undergone a total knee replacement amounted to $17,451 per patient. The physician reimbursement for ACDF represented 20.42% of the total, with the surgeon receiving 18.07% of the total reimbursement. Revision surgery, readmission, and emergency department reimbursement accounted for 0.71% of the total reimbursement. Reimbursement for rehabilitation services, including physical therapy, skilled nursing facilities, and home care, represented 3.11% of the total reimbursement. There was a significant variation in reimbursement among geographic regions in the United States (p < 0.001), with the highest in the West.
  
  
  CONCLUSIONS
  To our knowledge, this study is the first report on 90-day reimbursement per patient for one to two-level ACDF procedures in a Medicare cohort. Payments varied significantly among geographic locations. Our study provides a reimbursement benchmark for one to two-level ACDF procedures. Clarifying the payments relative to costs will help providers to understand whether a bundled payment for the ACDF procedure is economically viable.
authors.affiliation: Department of Orthopaedics, Wexner Medical Center at The Ohio State University, Columbus, Ohio.
authors.forename: Sohrab S
authors.initials: SS
authors.lastname: Virk
authors.affiliation: Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Phillips
authors.affiliation: Department of Orthopaedics, Wexner Medical Center at The Ohio State University, Columbus, Ohio safdar.khan@osumc.edu.
authors.forename: Safdar N
authors.initials: SN
authors.lastname: Khan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D017586:Diskectomy / Q000191:economics* / Q000379:methods; D017050:Episode of Care; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D011843:Radiculopathy / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D014481:United States