Medicare vs. Affordable Care Act reimbursement to deformity surgeons: Analysis of 3 scoliosis surgeries

2013

Summary

Surgeon reimbursement per hour work was calculated for 3 scoliosis surgeries done by 3 surgeons using rates from 2012 Medicare and the Affordable Care Act (ACA). Care included preop and postop visits through one year. Using 60% overhead, Medicare reimbursement: Small Scoliosis (levels L2-5) =$193.42/hour (ACA=$140.23/hour), Large Scoliosis (levels T11-S1) = $152.85/hour (ACA=$110.81/hour), Idiopathic Scoliosis=$94.59/hour (ACA=$68.57/hour). Average Salaries: Neurosurgeon $237.37/hour, Orthopedic Surgeon $200.04/hour. Deformity surgeons will need to become creative in order to earn what other surgeons make.

Introduction

The cost of spine care increases annually while surgeon reimbursement remains flat. The Affordable Care Act (ACA) includes a 27% decrease in payments to surgeons from 2012 Medicare levels, leaving some deformity surgeons to question their ability to care for Medicare or ACA patients.

Methods

Retrospective review of hospital records for patients undergoing 3 common deformity surgeries by 3 surgeons during 2012. Surgeries: 1) Small Degenerative Scoliosis (SDS)- 3 level laminectomy (lami), posterior spinal fusion (PSF) L2-5; 2) Adult Idiopathic Scoliosis (IS)- PSF T4-L4; 3) Large Degenerative Scoliosis (LDS)- PSF T11-S1, 3 level lami, 1 level TLIF. Time spent in patient care included global fee (preop area 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 care was averaged by surgeon, and divided by Medicare and ACA reimbursements to obtain $/hour payment for each type of surgery. Average pay/hour was reduced by a range of practice overhead (40%-70%).

Results

Operative times varied by surgery: SDS-5.6 hours (5.0-6.1 hours), IS–5.7 hours (4.5-8.5 hours), LDS–6.9 hours (range 5.0-8.3 hours). Days of hospital rounds: SDS–5.75 days (range 4-8 days), IS-5.6 days (range 4-9 days), LDS–6.1 days (range 4-9 days). Time spent in patient care included pre-op visits (0.45 hours), pre-op care (1.75 hours). Rounds were 0.5 hours/day. Postop office visits were 0.5 hours x3 global visits and 0.25 hours x 3 billable visits. Total patient care time: SDS-12.65 hours, IS–12.81 hours, LDS-14.26 hours. Using 60% overhead, surgeon reimbursement for Medicare: SDS =$193.42/hour (ACA=$140.23/hour), LDS =$152.85/hour (ACA=$110.81/hour), IS =$94.59/hour (ACA=$68.57/hour). Salary.com lists hourly pay: Neurosurgeon $237.37/hour, Orthopedic Surgeon $200.04/hour, Trauma Surgeon $162.88/hour.

Conclusion

Medicare and ACA reimbursement will impact the economics of deformity surgery. Whether this will impact patients’ access to care remains undetermined. Deformity surgeons must become creative in order to earn what average trauma, orthopedic, and neurosurgeons make.