DRG-based bundled reimbursement for lumbar fusion: implications for patient selection
DRG-based bundled reimbursement for lumbar fusion: implications for patient selection (Journal of Neurosurgery).
Under the Bundled Payments for Care Improvement (BPCI) initiative, Medicare reimburses for lumbar fusion without adjusting for underlying pathology. However, lumbar fusion is a widely used technique that can treat both degenerative and traumatic pathologies. In
other surgical cohorts, significant heterogeneity exists in resource use when comparing procedures for traumatic versus degenerative pathologies. If the same were true for lumbar fusion, BPCI would create a financial disincentive to treat specific patient
populations. The goal of this study was to compare hospital resource use for lumbar fusion between 2 patient populations: patients with spondylolisthesis and patients with lumbar vertebral fracture.
Under the proposed DRG (diagnosis-related group)–based BPCI, hospitals would be
reimbursed the same amount for lumbar fusion regardless of the diagnosis.
However, compared with fusion for spondylolisthesis, fusion for lumbar
vertebral fracture was associated with longer LOS, greater direct hospital
costs, and increased likelihood of being discharged to a post-acute care
facility. These findings suggest that the BPCI episode of care for lumbar
fusion dis-incentivizes treatment of trauma patients.
Quelle: Journal of Neurosurgery, 30.06.2019