Medicaid Reimbursement for Common Spine Procedures: Are Compensation Rates Consistent?

October 3, 2019

STUDY DESIGN:

.: Health Services Research OBJECTIVE..: The purpose of this study is (a) determine the variability of Medicaid (MCD) reimbursement for patients who require spine procedures, and (b) to assess how this compares to regional Medicare (MCR) reimbursement as a marker of access to spine surgery.

SUMMARY OF BACKGROUND DATA:

.: The current healthcare environment includes two major forms of government reimbursement: MCD and MCR, which are regulated and funded by the state and federal government, respectively.

METHODS:

.: MCD reimbursement rates from each state were obtained for eight spine procedures, utilizing online web searches: anterior cervical decompression and fusion (ACDF), posterior cervical decompression and fusion (PCDF), posterior lumbar decompression (PLD), single level posterior lumbar fusion, posterior fusion for deformity (less than 6 levels; 6-12 levels; 13+ levels), and lumbar microdiscectomy. Discrepancy in reimbursement for these procedures on a state-to-state basis, as well as overall differences in MCD versus MCR reimbursement, were determined. Procedures were examined to identify whether certain surgical interventions have greater discrepancy in reimbursement.

RESULTS:

.: The average MCD reimbursement was 78.4% of that for MCR. However, there was significant variation between states (38.8% to 140% of MCR for the combined eight procedures). On average, New York, New Jersey, Florida, and Rhode Island provided MCD reimbursements less than 50% of MCR reimbursements in the region. In total, 20 and 42 states provided less than 75 and 100% of MCR reimbursements, respectively. Based upon relative reimbursement, MCD appears to value microdiscectomy (84.1% of MCR; p = 0.10) over other elective spine procedures. Microdiscectomy also had the most inter-state variation in MCD reimbursement: 39.0 to 207.0% of MCR.

CONCLUSION:

.: Large disparities were found between MCR and MCD when comparing identical procedures. Further research is necessary to fully understand the impact of these significant differences. However, it is likely that these discrepancies lead to suboptimal access to necessary spine care.