Relative Value Unit (RVU) and Medicare Severity Diagnosis-related Group (MS-DRG) Reimbursement in Cervical Spinal Fusion: A 2011-2023 Trends Report.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-08-28 DOI:10.1097/BSD.0000000000001660

Shravan Asthana, Pranav M Bajaj, Jacob R Staub, Connor D Workman, Samuel G Reyes, Matthew A Follett, Alpesh A Patel, Wellington K Hsu, Srikanth N Divi

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Abstract

Study design: Level 3 retrospective database study.

Objective: This study aims to compare work RVU (wRVU), practice expense RVU (peRVU), malpractice RVU (mpRVU), and inflation-adjusted facility price alongside MS-DRG relative weight length of stay (LOS) for cervical spine fusions between 2011 and 2023.

Summary of background data: Both RVU and MS-DRG reimbursement have been studied in various surgical subspecialties; however, little investigation has centered on cervical spine fusions. To the best of our knowledge, this is the first study to investigate trends in RVU and MS-DRG reimbursement in cervical spine fusion throughout the COVID-19 pandemic.

Methods: Center for Medicaid and Medicare Services (CMS) physician fee schedule was queried between 2011 and 2023 for RVU and facility reimbursement using common single and multilevel anterior and posterior cervical fusion codes. RVU facility prices were inflation adjusted to 2023. MS-DRG reimbursement data from 2011 to 2022 were compiled for cervical spinal fusion procedures with major complication or comorbidity (MCC) 471, complication or comorbidity (CC) 472, and without CC/MCC 473. Compound annual growth rates (CAGRs), Mean Annual Change, and yearly percent changes were calculated.

Results: No changes in wRVU were seen for all cervical CPT codes; however, the CAGR of peRVU (-0.51%±0.60%) and mpRVU (0.69%±0.41%) demonstrated marginal fluctuations. Every CPT code displayed an inflation-adjusted facility price decrease (-2.18%±0.24%). When assessing MS-DRG, there were marginal changes in geometric mean LOS (0.17%±0.45%), arithmetic mean LOS (-0.15%±0.84%), and relative weight (1.09%±0.68%). Unlike RVU reimbursement, the yearly percent change differs between each MS-DRG code.

Conclusions: Inflation-adjusted RVU reimbursement facility prices demonstrated a consistent decrease, while DRG code reimbursement stayed relatively consistent over the study period. This data may help surgeons and hospitals become cognizant of temporal variations in reimbursement patterns as it may affect their personal practice.

Level of evidence: Level III retrospective study.

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颈椎融合术的相对价值单位（RVU）和医疗保险严重程度诊断相关组（MS-DRG）报销：2011-2023 年趋势报告》。

研究设计三级回顾性数据库研究：本研究旨在比较 2011 年至 2023 年颈椎融合术的工作 RVU（wRVU）、诊疗费用 RVU（peRVU）、渎职 RVU（mpRVU）和通货膨胀调整后的设施价格，以及 MS-DRG 相对权重住院时间（LOS）：对各种外科亚专科的 RVU 和 MS-DRG 补偿都进行过研究，但以颈椎融合术为中心的研究很少。据我们所知，这是第一项在 COVID-19 大流行期间调查颈椎融合术 RVU 和 MS-DRG 补偿趋势的研究：方法：在 2011 年至 2023 年期间，对医疗补助和医疗保险服务中心（CMS）的医生收费表进行了查询，以了解使用常见的单级和多级颈椎前路和后路融合术代码的 RVU 和设备报销情况。RVU 设施价格根据 2023 年的通货膨胀率进行了调整。针对有主要并发症或合并症（MCC）471、并发症或合并症（CC）472 和无 CC/MCC 473 的颈椎融合术，编制了 2011 年至 2022 年的 MS-DRG 报销数据。计算了复合年增长率 (CAGR)、平均年变化率和年百分比变化率：结果：所有宫颈 CPT 代码的 wRVU 均无变化；但 peRVU（-0.51%±0.60%）和 mpRVU（0.69%±0.41%）的复合年增长率略有波动。每个 CPT 代码都出现了通货膨胀调整后的设施价格下降（-2.18%±0.24%）。在评估 MS-DRG 时，几何平均 LOS（0.17%±0.45%）、算术平均 LOS（-0.15%±0.84%）和相对权重（1.09%±0.68%）均略有变化。与 RVU 报销不同的是，每个 MS-DRG 代码的年度百分比变化各不相同：通胀调整后的 RVU 补偿设施价格持续下降，而 DRG 代码的补偿在研究期间保持相对稳定。这些数据可以帮助外科医生和医院了解报销模式的时间变化，因为这可能会影响他们的个人实践：III 级回顾性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.