Impact of Certificate of Need on Lumbar Discectomy Reimbursement and Utilization

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The Certificate of Need (CON) program was established to respond to increasing healthcare costs; however, its impact on spine surgery trends is not well understood. The purpose of this study was to evaluate the impact of CON status on utilization of single-level lumbar discectomy. A combined Medicare and private payor database was used to identify single-level lumbar discectomies performed from 2007 to 2015. Utilization and reimbursement trends were compared using the compound annual growth rate (CAGR) with reimbursement adjusted by the consumer price index. In total, 30,617 lumbar discectomies were analyzed. Procedure utilization increased across all settings. CAGR was highest in the outpatient CON group (19.7%) and lowest in the inpatient non-CON group (0.5%). Reimbursement increased in the outpatient setting (CAGR: 1.2% CON, 1.0% non- CON), but decreased in the inpatient sett ing (CAGR: -6.1% CON, -5.5% non-CON). These trends are important to consider in a value-based healthcare environment. (Journal of Surgical Orthopaedic Advances 31(1):026–029, 2022)

Key words: certificate-of-need, lumbar discectomy, cost, government regulation

SKU: JSOA-2022-31-1-4 Categories: , Tags: , , ,

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Chason Ziino, MD; Abiram Bala, MD; Shay Warren, MD; and Ivan Cheng, MD

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