Assessing medicare Advantage trends in lumbar spine surgery: Balancing financial Appeal vs patient outcomes

Aims & objectives

To assess coverage trends and demographic characterization of patients opting for Medicare Advantage (MA) plans and its impact on 90-day complications risks in patients undergoing lumbar fusion surgery.

Material & methods

This study utilized the Pearldiver database, Mariner161Ortho dataset, containing de-identified patient records from 01/01/2010–10/31/2022. Patient records for primary lumbar fusion procedures in patients aged 65 and above were retrieved, and were categorized into traditional medicare (TM), MA, and other plans. Outcomes included an assessment of the trends of utilization, demographic characterization of patients and their comorbidities, and 90-day post-operative complications risks. Statistical analysis involved T-tests, chi-square tests, and multivariable regression, with significance defined as a p-value <0.05.

Results

A total of 270,300 records were retrieved [TM (134,224 or 49.66%), MA (109,015 or 40.33%), and other plans (27,061 or 10.01%)]. MA utilization increased substantially (24.13%–47.99%), while TM cases declined (55.63%–43.26%). Demographic characterization showed that MA patients, compared to TM, were utilized by a higher percentage of men, with higher Elixhauser Comorbidity Index (ECI) scores, greater average reimbursement, and higher mean family income. Furthermore, all comorbidities were significantly more prevalent in the MA group. In terms of complications, MA plans demonstrated an increased risk of 90-day wound-related, medical, neurological, and long-term complications.

Conclusion

While MA plans may appear attractive for patients considering lumbar fusion surgery, spine surgeons need to thoroughly assess and discuss with patients the 90-day complication risks associated with MA coverage.