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Federico VP, Zavras AG, Butler A, Nolte MT, Munim MA, Lopez GD, DeWald C, An HS, Colman MW, Phillips FM. Medicare Reimbursement Rates and Utilization Trends in Sacroiliac Joint Fusion. J Am Acad Orthop Surg 2023; 31:923-930. [PMID: 37192412 DOI: 10.5435/jaaos-d-22-00800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Sacroiliac joint (SIJ) fusion is a surgical treatment option for SIJ pathology in select patients who have failed conservative management. More recently, minimally invasive surgical (MIS) techniques have been developed. This study aimed to determine the trends in procedure volume and reimbursement rates for SIJ fusion. METHODS Publicly available Medicare databases were assessed using the National Summary Data Files for 2010 to 2020. Files were organized according to current procedural terminology (CPT) codes. CPT codes specific to open and MIS SI joint fusion (27279 and 27280) were identified and tracked. To track surgeon reimbursements, the CMS Medicare Physician Fee Schedule Look-Up Tool was used to extract facility prices. Descriptive statistics and linear regression were used to evaluate trends in procedure volume, utilization, and reimbursement rates. Compound annual growth rates were calculated, and discrepancies in inflation were corrected for using the Consumer Price Index. RESULTS A total of 33,963 SIJ fusions were conducted in the Medicare population between 2010 and 2020, with an overall increase in procedure volume of 2,350.9% from 318 cases in 2010 to 7,794 in 2020. Since the introduction of the 27279 CPT code in 2015, 8,806 cases (31.5%) have been open and 19,120 (68.5%) have been MIS. Surgeon reimbursement for open fusions increased nominally by 42.8% (inflation-adjusted increase of 20%) from $998 in 2010 to $1,425 in 2020. Meanwhile, reimbursement for MIS fusion experienced a nominal increase of 58.4% (inflation-adjusted increase of 44.9%) from $582 in 2015 to $922 in 2020. CONCLUSION SIJ fusion volume in the Medicare population has increased substantially in the past 10 years, with MIS SIJ fusion accounting for most of the procedures since the introduction of the 27279 CPT code in 2015. Reimbursement rates for surgeons have also increased for both open and MIS procedures, even after adjusting for inflation.
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Affiliation(s)
- Vincent P Federico
- From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Van Munster JJCM, de Weerdt V, Halperin IJY, Zamanipoor Najafabadi AH, van Benthem PPG, Schoonman GG, Moojen WA, van den Hout WB, Atsma F, Peul WC. Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes. Global Spine J 2022; 12:1841-1851. [PMID: 34955052 PMCID: PMC9609525 DOI: 10.1177/21925682211064855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVE To describe whether practice variation studies on surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation, and to inform quality improvement in clinical practice. Secondary aim was to describe whether variation changed over time. METHODS Literature databases were searched up to May 4th, 2021. To define whether study design was appropriate to identify unwarranted variation, we extracted data on level of aggregation, study population, and case-mix correction. To define whether studies were appropriate to achieve quality improvement, data were extracted on outcomes, explanatory variables, description of scientific basis, and given recommendations. Spearman's rho was used to determine the association between the Extreme Quotient (EQ) and year of publication. RESULTS We identified 34 articles published between 1990 and 2020. Twenty-six articles (76%) defined the diagnosis. Prior surgery cases were excluded or adjusted for in 5 articles (15%). Twenty-three articles (68%) adjusted for case-mix. Variation in outcomes was analyzed in 7 articles (21%). Fourteen articles (41%) identified explanatory variables. Twenty-six articles (76%) described the evidence on effectiveness. Recommendations for clinical practice were given in 9 articles (26%). Extreme Quotients ranged between 1-fold and 15-fold variation and did not show a significant change over time (rho= -.33, P= .09). CONCLUSIONS Practice variation research on surgery in patients with degenerative disc disease showed important limitations to identify unwarranted variation and to achieve quality improvement by public reporting. Despite the availability of new evidence, we could not observe a significant decrease in variation over time.
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Affiliation(s)
- Juliëtte J. C. M. Van Munster
- Leiden University Medical Center
(LUMC), Leiden, Netherlands,University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands,Juliëtte J. C. M. van Munster, Department
of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical
Center, 2300 RC Leiden 2333 ZA, Netherlands.
| | - Vera de Weerdt
- Talma Institution, Vrije Universiteit
Amsterdam, the Netherlands & Amsterdam University Medical Centers,
Amsterdam, the Netherlands
| | - Ilan J. Y. Halperin
- Leiden University Medical Center
(LUMC), Leiden, Netherlands,University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands
| | - Amir H. Zamanipoor Najafabadi
- University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands
| | | | | | - Wouter A. Moojen
- University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands
| | | | - Femke Atsma
- Radboud University Medical
Center/Radboud Institute for Health Sciences/Scientific Center for
Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands
| | - Wilco C. Peul
- University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands
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Ahmadian H, Mageswaran P, Walter BA, Blakaj DM, Bourekas EC, Mendel E, Marras WS, Soghrati S. A digital twin for simulating the vertebroplasty procedure and its impact on mechanical stability of vertebra in cancer patients. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3600. [PMID: 35347880 PMCID: PMC9287026 DOI: 10.1002/cnm.3600] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/03/2022] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
We present the application of ReconGAN, introduced in a previous study, for simulating the vertebroplasty (VP) operation and its impact on the fracture response of a vertebral body. ReconGAN consists of a Deep Convolutional Generative Adversarial Network (DCGAN) and a finite element based shape optimization algorithm to virtually reconstruct the trabecular bone microstructure. The VP procedure involves injecting shear-thinning liquid bone cement through a needle in the trabecular region to reinforce a diseased or fractured vertebra. To simulate this treatment modality, computational fluid dynamics (CFD) is employed to predict the morphology of the injected cement within the bone microstructure. A power-law equation is utilized to characterize the non-Newtonian shear-thinning behavior of the polymethyl methacrylate (PMMA) bone cement during injection simulations. The CFD model is coupled with the level-set method to simulate the motion of the interface separating bone cement and bone marrow. After predicting the cement morphology, a data co-registration algorithm is employed to transform the CFD model to a high-fidelity continuum damage mechanics (CDM) finite element model of the augmented vertebra for predicting the fracture response. A feasibility study is presented to demonstrate the ability of this CFD-CDM framework to investigate the effect of VP on the mechanical integrity of the vertebral body in a cancer patient with a lytic metastatic tumor.
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Affiliation(s)
- Hossein Ahmadian
- Department of Integrated Systems EngineeringThe Ohio State UniversityColumbusOhioUSA
| | - Prasath Mageswaran
- Department of Integrated Systems EngineeringThe Ohio State UniversityColumbusOhioUSA
| | - Benjamin A. Walter
- Department of Biomedical EngineeringThe Ohio State UniversityColumbusOhioUSA
| | - Dukagjin M. Blakaj
- Department of Radiation OncologyThe Ohio State UniversityColumbusOhioUSA
| | - Eric C. Bourekas
- Department of Neurological SurgeryThe Ohio State UniversityColumbusOhioUSA
- Department of RadiologyThe Ohio State UniversityColumbusOhioUSA
- Department of NeurologyThe Ohio State UniversityColumbusOhioUSA
| | - Ehud Mendel
- Department of Radiation OncologyThe Ohio State UniversityColumbusOhioUSA
- Department of Neurological SurgeryThe Ohio State UniversityColumbusOhioUSA
- Department of OrthopedicsThe Ohio State UniversityColumbusOhioUSA
| | - William S. Marras
- Department of Integrated Systems EngineeringThe Ohio State UniversityColumbusOhioUSA
| | - Soheil Soghrati
- Department of Mechanical and Aerospace EngineeringThe Ohio State UniversityColumbusUSA
- Department of Materials Science and EngineeringThe Ohio State UniversityColumbusOhioUSA
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Hogan WB, Philips A, Alsoof D, McDonald CL, Anderson G, Zhang AS, Daniels AH. Kyphoplasty and Vertebroplasty Performed by Surgeons versus Nonsurgeons: Trends in Procedure Rates, Complications, and Revisions. World Neurosurg 2022; 164:e518-e524. [PMID: 35552034 DOI: 10.1016/j.wneu.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vertebral compression fractures are the most common fragility fractures affecting osteoporotic patients. This study evaluated volume trends and outcomes across specialties performing cement augmentation procedures. METHODS Patients were identified using Current Procedural Terminology codes for vertebroplasty or kyphoplasty from 2010 to 2019. Patients were grouped by surgical providers (orthopedic surgery and neurological surgery) or nonsurgical providers (anesthesia, pain medicine, radiology, and physical medicine and rehabilitation). Outcomes recorded included reoperation rates and postoperative complications occurring within 30 days. Logistic regression was employed to account for potential confounding variables, and odds ratios were obtained. RESULTS Inclusion criteria were met by 80,864 patients who received cement augmentation. Surgeon specialists performed 51.7% of all procedures. Of procedures carried out by nonsurgeon specialists, radiologists performed the most. Despite a stable number of procedures performed over the period, the percentage of procedures performed by surgeons decreased from 58.8% to 49.9% (P < 0.001). Patients with procedures performed by surgeons experienced lower odds of reoperation at 30 days (P < 0.001) and 1 year (P < 0.001), but 5-year and overall rates were not significant (P > 0.05). Surgical patients had lower odds of acute kidney injury (P < 0.004) and pulmonary embolism (odds ratio = 0.62, P < 0.001), yet increased odds of surgical site infection (P < 0.001). CONCLUSIONS Kyphoplasties and vertebroplasties are increasingly performed by nonsurgeon specialists. Although early reoperation rates are higher for nonsurgeon specialists, 5-year and overall reoperation rates were similar. Differing complication rates may relate to patient selection rather than operative technique and can be investigated with future studies.
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Affiliation(s)
- William B Hogan
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alexander Philips
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - George Anderson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Andrew S Zhang
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
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Schartz D, Young E. Medicare Reimbursement Trends for Interventional Radiology Procedures: 2012 to 2020. J Vasc Interv Radiol 2021; 32:447-452. [PMID: 33454179 DOI: 10.1016/j.jvir.2020.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the reimbursement trends for interventional radiology (IR) procedures from 2012 to 2020. MATERIALS AND METHODS Reimbursement data from the Physician Fee Schedule look-up tool from the Centers for Medicare and Medicaid Services was compiled for 20 common IR procedures. The authors then investigated compensation trends after adjusting for inflation and from the unadjusted data between 2012 and 2020. RESULTS From 2012 to 2020, the mean unadjusted reimbursement for procedures decreased by -6.9% (95% confidence interval [CI], -13.5% to -0.34%). This trend was even more profound after inflation was taken into account, with a mean decline in adjusted reimbursement of -18.7% (95% CI, -24.4% to -12.9%) during the study period, with a mean yearly decline of -2.8%. The difference between the mean unadjusted and adjusted payment amounts was significant (P = .012). Similarly, linear regression analysis of the adjusted average reimbursement across all procedures revealed an overall decline from 2012 to 2020 (R2 = 0.97), indicating a steady decline in reimbursement over time. CONCLUSIONS In just under a decade, IR has experienced significant reimbursement cuts by Medicare, as demonstrated by both the unadjusted and inflation-adjusted payment trends. Knowledge of these trends is critically important for practicing interventional radiologists, leaders within the field, and legislators, who may play a role in formulating future reimbursement schedules for IR. These data may be used to help support more amenable reimbursement plans to sustain and facilitate the growth of the specialty.
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Affiliation(s)
- Derrek Schartz
- University of Rochester Medical Center, Department of Imaging Sciences, 601 Elmwood Avenue, Rochester, NY, 14642.
| | - Emily Young
- University of Rochester Medical Center, Department of Imaging Sciences, 601 Elmwood Avenue, Rochester, NY, 14642
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