Costs associated with a 90-day Episode of Care following a Single-Level Anterior Lumbar Interbody Fusion (ALIF).

January 10, 2020

INTRODUCTION:

Anterior Lumbar Interbody Fusion (ALIF) is a commonly performed surgical procedure for the management of degenerative lumbar spine pathologies. Despite an increasing number of ALIFs being performed nationally, no study has evaluated the costs associated with the 90-day episode of care following the surgery.

MATERIALS AND METHODS:

The 2007-2016 Humana Administrative Claims (HAC) dataset, a national database of Commercial and Medicare Advantage (MA) beneficiaries, was queried using Current Procedural Terminology code 22558 for patients undergoing single-level ALIFs. Ninety-day costs were defined on the basis of the following categories (facility, surgeon, anesthesia, other hospitalization costs and services, radiology, office visits, physical therapy/rehab, emergency department visits and readmissions).

RESULTS:

A total of 365 ALIFs (MA=244; Commercial=121) were included in the analysis. The average 90-day cost of single-level ALIF was $25,568 and $51,741 for MA and Commercial enrollees respectively. The major proportion of 90-day costs was attributable to facility reimbursements (74%-76%), followed by surgeon costs (9%-11%). Post-acute care (office visits and physical therapy/rehab) were not major drivers of 90-day costs, consisting of only 0.7%-1.3% of the total 90-day reimbursement. Among patients who got readmitted, the cost of the readmission increased the average 90-day cost by 65%-66%.

CONCLUSIONS:

Facility costs were the major driver of a stipulated 90-day reimbursement for patients undergoing a single-level ALIF. Health-policy makers and providers can utilize this data to better understand the distribution of costs in a stipulated bundled-payment model for ALIFs, and allow them to identify areas where cost-reduction strategies can be carried out.