Race, Region, and Reimbursement: Sociodemographic Variations in Medicare Payments for Spine Surgery in the United States, 2014-2022.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-05-13 DOI:10.1097/BSD.0000000000001834

Daniel Schneider, Ethan D L Brown, Harshal A Shah, Sheng-Fu L Lo, Daniel M Sciubba

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引用次数: 0

Abstract

Study design: Retrospective.

Objective: Assess whether Medicare adjustments adequately correct for systemic population-level payment variations.

Summary of background data: Medicare currently uses payment adjustments for spine surgery, including clinical risk, geography, and socioeconomic status.

Methods: Using Medicare fee-for-service claims from 2014 to 2022, we conducted a retrospective cohort study of spine-related diagnosis-related groups (459 state-year observations). Multivariable regression models examined associations between payments and sociodemographic factors, controlling for existing Medicare adjustments.

Results: Significant disparities persisted despite adjustment. Each percentage-point increase in Black beneficiaries was associated with $172 higher payments (95% CI: $111-$232, P<0.001), while Hispanic population increases showed the opposite effect (-$174 per point; 95% CI: -$252 to -$96, P<0.001). Areas with above-median female proportions had $1596 higher payments (95% CI: $580-$2611, P=0.002). Regional variations were notable: payments were higher in the West ($11,060), Northeast ($5762), and Midwest ($3210) than in the South (all P<0.001).

Conclusions: Medicare payments for inpatient spine care demonstrate persistent demographic disparities unaddressed by current risk-adjustment models. Future research should determine whether these variations indicate appropriate adjustments for care needs or systematic underpayment or overpayment for the treatment of particular populations.

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种族、地区和报销：2014-2022年美国脊柱外科医疗保险支付的社会人口统计学变化

研究设计：回顾性。目的：评估医疗保险调整是否足以纠正系统性人群水平的支付差异。背景资料摘要：医疗保险目前对脊柱手术进行支付调整，包括临床风险、地理位置和社会经济地位。方法：使用2014年至2022年的医疗保险按服务收费索赔，我们对脊柱相关诊断相关组（459个州年度观察）进行了回顾性队列研究。多变量回归模型检验了支付与社会人口因素之间的关系，控制了现有的医疗保险调整。结果：尽管调整，显著差异仍然存在。黑人受益人每增加一个百分点，支付额就会增加172美元（95% CI: 111- 232美元）。结论：住院脊柱护理的医疗保险支付表明，目前的风险调整模型无法解决持续的人口差异。未来的研究应确定这些变化是否表明对护理需求的适当调整或对特定人群治疗的系统性支付不足或支付过高。

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.