Affordable Care Act (Obamacare) and Medicare reimbursement for spine surgeons

2013

Summary

Surgeon reimbursement per hour of work for 2012 Medicare and Accountable Care Act (ACA) patients (27% below Medicare) was evaluated using 4 common spine surgeries done by 10 spine surgeons at one hospital. Care included pre-op and postop visits through one year, offset by a range of overhead percentages. Reimbursement/hour was compared to other professions. Using 60% overhead, hourly pay for Medicare single-level fusion paid $131 (ACA=$96); laminectomy paid $55 (ACA=$39, or the same as a nurse).

Introduction

The Affordable Care Act (ACA) reimbursement for surgeons is 27% below 2012 Medicare, leading some surgeons to question their ability to care for these patients. We examined surgeon reimbursement/hour work for Medicare and ACA patients using 4 common spine surgeries. Surgeon hourly pay was compared to other professions.

Methods

Data was retrospectively reviewed for all patients undergoing 4 common surgeries (1 level laminectomy, 1 level posterior spinal fusion (PSF) and TLIF, 2 level PSF/1 level TLIF, anterior cervical discectomy/fusion/plating (ACDFP)) by 10 surgeons during 2012. Time spent in patient care included in the surgical fee (pre-op discussion, intubation, positioning, surgery, dictation, family discussion, rounding time, postop visits at 2, 6, and 12 weeks) and additional billable care (surgical consult, pre-op visit, postop visits at 6, 9, and 12 months) were recorded. The total hours spent in surgeon-provided care was divided by Medicare and ACA reimbursements to obtain $/hour surgeon payment for each surgery, and adjusted by a range of practice overhead (40%, 50%, 60% and 70%).

Results

Operative times varied by surgery: lami- 2.1 hours (range 1.4-3.4 hours), PSF/TLIF- 2.8 hours (range 2.1-4.0 hours), 2 level PSF/TLIF- 3.7 hours (range 2.1-5.6 hours), ACDFP- 2.3 hours (range 1.5-3.3 hours). Hospital length of stay: Lami- 1 day (range 1-3 days), PSF/TLIF- 3 days (range 1-5 days), 2 level PSF/TLIF- 3 days (range 1-6 days), and ACDFP- 1 day (range 1-2 days). Additional preop care (1.75 hours); rounds were 0.5 hours/day. Postop office visits: 0.5 hours x 3 global visits (non-billable), 0.25 hours x 3 billable visits. Total care time: Lami- 8.85 hours, PSF/TLIF- 10.58 hours, 2 level PSF/TLIF - 11.42 hours, ACDFP - 7.82 hours. Using 60% overhead, average surgeon earnings for Medicare: Lami=$54.85/hour (ACA=$39.77), PSF/TLIF=$131.96/hour (ACA=95.67), 2 level PSF/TLIF=$138.28/hour (ACA=$100.25), ACDFP=$130.37/hour (ACA=$94.52). U.S. Department of Labor and Statistics lists of hourly pay: Oral surgeon $112.75, Chief Executive $107.41, Lawyer $79.54, Veterinarians $62.12, Physician Assistants $45.95, Registered Nurses $39.93.

Conclusion

Medicare and ACA reimbursement will impact the economic viability of many surgical practices, in some cases paying the surgeon the same as a nurse.