Soham Ghoshal, Margaret L Sullivan, Shanika D Silva, Craig M Birch, M Timothy Hresko, Grant D Hogue
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引用次数: 0
Abstract
Purpose: To evaluate reimbursement trends and surgical volumes associated with computer-assisted navigation (CAN) in pediatric posterior spinal fusion (PSF), with a focus on the impact of payer mix on institutional financial sustainability.
Methods: We conducted a retrospective cohort study of patients aged 11-19 years undergoing CAN-assisted PSF at a single pediatric institution from 2021 to 2024. Billing records associated with CPT code 61,783 (computer-assisted spinal navigation add-on) were used to identify procedures. Annual procedure volumes were calculated and analyzed by payer type (private vs. public). Matched payments were adjusted to 2024 USD and analyzed using Wilcoxon rank-sum tests.
Results: A total of 759 CAN-PSF procedures were analyzed, with 58% billed to private insurance, 37% to public insurance, and 5% to other payers. Procedure volume increased 70.5% from 2021 to 2024 (CAGR 19.5%). Across all payers, median reimbursement rates declined from 74% in 2021 to 67% in 2024 (p < 0.01). Private insurer reimbursement declined from 81 to 68%, representing a 13% decrease (p < 0.01), while public insurer reimbursement declined from 11 to 9%, representing a 2% decrease (p < 0.01). An inverse relationship was observed between rising procedure volume and declining reimbursement rates.
Conclusion: Although CAN utilization in pediatric PSF significantly increased from 2021 to 2024, declining reimbursement rates pose financial challenges for institutions. These trends may limit equitable access to advanced surgical technologies, highlighting a need for policy reforms or adjustments in reimbursement practices to sustain CAN integration in pediatric spine surgery.
期刊介绍：
Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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