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Kim AG, Rizk AA, Ina JG, Magister SJ, Salata MJ. Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy. J Am Acad Orthop Surg 2024; 32:604-610. [PMID: 38626441 DOI: 10.5435/jaaos-d-23-00080] [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: 01/24/2023] [Accepted: 02/25/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures. METHODS From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends. RESULTS Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% ( P < 0.001) and 24.64% ( P < 0.001), respectively, over the study period. DISCUSSION Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.
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Affiliation(s)
- Andrew G Kim
- From the Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
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Adjei J, Tang M, Lipa S, Oyekan A, Woods B, Mesfin A, Hogan MV. Addressing the Impact of Race and Ethnicity on Musculoskeletal Spine Care in the United States. J Bone Joint Surg Am 2024; 106:631-638. [PMID: 38386767 DOI: 10.2106/jbjs.22.01155] [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] [Indexed: 02/24/2024]
Abstract
➤ Despite being a social construct, race has an impact on outcomes in musculoskeletal spine care.➤ Race is associated with other social determinants of health that may predispose patients to worse outcomes.➤ The musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends.➤ Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives.
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Affiliation(s)
- Joshua Adjei
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Tang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shaina Lipa
- Department of Orthopedic Surgery, Brigham and Woman's Hospital, Boston, Massachusetts
| | - Anthony Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barrett Woods
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, Medstar Orthopaedic Institute, Georgetown University School of Medicine, Washington, DC
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Nagata K, Dimar JR, Carreon LY, Glassman SD. Preoperative Optimization: Risk Factors for Perioperative Complications and Preoperative Modification. Neurosurg Clin N Am 2023; 34:505-517. [PMID: 37718097 DOI: 10.1016/j.nec.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Adult spinal deformity (ASD) is common and the complication rate in ASD surgery is high due to its invasiveness. There are several factors that increase the risk of complications with ASD surgery. These include age, past medical history, frailty, osteoporosis, or operative invasiveness. Risk factors for perioperative complications can be categorized as modifiable and non-modifiable. The purpose of this article is to present the current available evidence on risk factors for perioperative complications, with a focus on frailty, osteoporosis, surgical site infection prevention, and hip-spine syndrome. In addition, we present the latest evidence for patient-specific surgical risk assessment and surgical planning.
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Affiliation(s)
- Kosei Nagata
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
| | - John R Dimar
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
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Holzapfel DE, Meyer M, Thieme M, Pagano S, von Kunow F, Weber M. Delay of total joint replacement is associated with a higher 90-day revision rate and increased postoperative complications. Arch Orthop Trauma Surg 2023; 143:3957-3964. [PMID: 36333532 PMCID: PMC9638434 DOI: 10.1007/s00402-022-04670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Delay of elective surgeries, such as total joint replacement (TJR), is a common procedure in the current pandemic. In trauma surgery, postponement is associated with increased complication rates. This study aimed to evaluate the impact of postponement on surgical revision rates and postoperative complications after elective TJR. METHODS In a retrospective analysis of 10,140 consecutive patients undergoing primary total hip replacement (THR) or total knee replacement (TKR) between 2011 and 2020, the effect of surgical delay on 90-day surgical revision rate, as well as internal and surgical complication rates, was investigated in a university high-volume arthroplasty center using the institute's joint registry and data of the hospital administration. Moreover, multivariate logistic regression models were used to adjust for confounding variables. RESULTS Two thousand four hundred and eighty TJRs patients were identified with a mean delay of 13.5 ± 29.6 days. Postponed TJR revealed a higher 90-day revision rate (7.1-4.5%, p < 0.001), surgical complications (3.2-1.9%, p < 0.001), internal complications (1.8-1.2% p < 0.041) and transfusion rate (2.6-1.8%, p < 0.023) than on-time TJR. Logistic regression analysis confirmed delay of TJRs as independent risk factor for 90-day revision rate [OR 1.42; 95% CI (1.18-1.72); p < 0.001] and surgical complication rates [OR 1.51; 95% CI (1.14-2.00); p = 0.04]. CONCLUSION Alike trauma surgery, delay in elective primary TJR correlates with higher revision and complication rates. Therefore, scheduling should be performed under consideration of the current COVID-19 pandemic. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
- Dominik Emanuel Holzapfel
- Department of Orthopaedic Surgery, Medical Center, Regensburg University, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Matthias Meyer
- Department of Orthopaedic Surgery, Medical Center, Regensburg University, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Max Thieme
- Department of Orthopaedic Surgery, Medical Center, Regensburg University, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Stefano Pagano
- Department of Orthopaedic Surgery, Medical Center, Regensburg University, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Frederik von Kunow
- Department of Orthopaedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, Regensburg, Germany
| | - Markus Weber
- Department of Orthopaedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, Regensburg, Germany
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DePledge L, Louie PK, Drolet CE, Shen J, Nemani VM, Leveque JCA, Sethi RK. Incidence, etiology and time course of delays to adult spinal deformity surgery: a single-center experience. Spine Deform 2023; 11:1019-1026. [PMID: 36773216 PMCID: PMC9918809 DOI: 10.1007/s43390-023-00658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/28/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE We sought to determine the incidence, origin, and timeframe of delays to adult spinal deformity surgery so that institutions using preoperative multidisciplinary patient assessment teams might better anticipate and address these potential delays. METHODS Complex spine procedures for treatment of adult spinal deformity from 1/1/18 to 8/31/21 were identified. Procedures for infection, tumor, and urgent/emergent cases were excluded. Operations delayed due to COVID or those that were performed outside of our established perioperative care pathway were also excluded. The electronic health record was used to identify the etiology and timeline of all pre- and peri-operative delays. RESULTS Of 235 patients scheduled for complex spine surgery, 193 met criteria for inclusion. Of these patients, 35 patients experienced a surgical delay (18.1%) with a total of 41 delays recorded. Reasons for delay include medically unoptimized (25.6%), intraoperative complication (17.9%), patient directed delay (17.9%), patient illness/injury (15.4%), scheduling complication (10.3%), insurance delay/denial (5.1%), and unknown (2.6%). Twenty-four delays experienced by 22 individuals occurred within 7 days of their scheduled surgery date. CONCLUSION At a single multidisciplinary center, most delays to adult spinal deformity surgery occur before a patient is admitted to the hospital, and for recommendations of additional medical workup/clearance. We suspect that the preoperative protocol might increase pre-admission delays for unoptimized patients, as the protocol is intended to ensure patients receive surgery only when they are medically ready. Further research is needed to determine the economic and system impact of delays related to a preoperative optimization protocol weighed against the reduction in adverse events these protocols can provide.
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Affiliation(s)
- Lisa DePledge
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Philip K Louie
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA.
| | - Cari E Drolet
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Jesse Shen
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Venu M Nemani
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Jean-Christophe A Leveque
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Rajiv K Sethi
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
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Tarawneh OH, Garay-Morales S, Liu IZ, Pakhchanian H, Kazim SF, Roster K, McDaniel L, Tabaie SA, Vellek J, Raiker R, Schmidt MH, Bowers CA, Tannoury T, Tannoury C. Impact of COVID-19 on Spinal Diagnosis and Procedural Volume in the United States. Global Spine J 2023:21925682231153083. [PMID: 36688402 PMCID: PMC9892815 DOI: 10.1177/21925682231153083] [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: 01/24/2023] Open
Abstract
STUDY DESIGN Retrospective analysis of a national database. OBJECTIVES COVID-19 resulted in the widespread shifting of hospital resources to handle surging COVID-19 cases resulting in the postponement of surgeries, including numerous spine procedures. This study aimed to quantify the impact that COVID-19 had on the number of treated spinal conditions and diagnoses during the pandemic. METHODS Using CPT and ICD-10 codes, TriNetX, a national database, was utilized to quantify spine procedures and diagnoses in patients >18 years of age. The period of March 2020-May 2021 was compared to a reference pre-pandemic period of March 2018-May 2019. Each time period was then stratified into four seasons of the year, and the mean average number of procedures per healthcare organization was compared. RESULTS In total, 524,394 patient encounters from 53 healthcare organizations were included in the analysis. There were significant decreases in spine procedures and diagnoses during March-May 2020 compared to pre-pandemic levels. Measurable differences were noted for spine procedures during the winter of 2020-2021, including a decrease in lumbar laminectomy and anterior cervical arthrodesis. Comparing the pandemic period to the pre-pandemic period showed significant reductions in most spine procedures and treated diagnoses; however, there was an increase in open repair of thoracic fractures during this period. CONCLUSIONS COVID-19 resulted in a widespread decrease in spinal diagnosis and treated conditions. An inverse relationship was observed between new COVID-19 cases and spine procedural volume. Recent increases in procedural volume from pre-pandemic levels are promising signs that the spine surgery community has narrowed the gap in unmet care produced by the pandemic.
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Affiliation(s)
| | | | - Ivan Z. Liu
- The Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Haig Pakhchanian
- George Washington University School of Medicine, Washington, DC, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Katie Roster
- New York Medical College, School of Medicine, Valhalla, NY, USA
| | - Lea McDaniel
- George Washington University School of Medicine, Washington, DC, USA
| | - Sean A. Tabaie
- Department of Orthopedic Surgery, Children’s National Hospital, Washington, DC, USA
| | - John Vellek
- New York Medical College, School of Medicine, Valhalla, NY, USA
| | - Rahul Raiker
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Tony Tannoury
- Department of Orthopaedic Surgery, Boston University, Boston, MA, USA
| | - Chadi Tannoury
- Department of Orthopaedic Surgery, Boston University, Boston, MA, USA
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