Chief Resident & Enfolded Spine Fellow Northwell Health Manhasset, NY, US
Introduction: Medicare employs multiple payment adjustments for spine surgery, including clinical risk, geography, and socioeconomic status. Whether these adjustments adequately address systematic payment variations across diverse populations remains unclear.
Methods: Using Medicare fee-for-service claims data from 2014-2022, we conducted a retrospective cohort study examining payments for spine-related diagnosis-related groups (n = 459 state-year observations). Multivariable regression models assessed associations between payments and sociodemographic factors while controlling for existing Medicare payment adjustments.
Results: Despite controlling for factors incorporated in Medicare's payment methodology, significant disparities persisted. Each percentage point increase in Black beneficiary population was associated with $172 higher payments (95% CI: $111 to $232, p< 0.001), while higher Hispanic population percentages showed opposite effects (-$174 per point; 95% CI: -$252 to -$96, p< 0.001). Areas with above-median female beneficiary proportions had $1,596 higher payments (95% $580 to $2,611, p=0.002). Regional variations remained substantial, with West ($11,060), Northeast ($5,762), and Midwest ($3,210) showing higher payments than South (all p< 0.001). State-level analysis and potential circularity with Medicare's adjustment mechanisms limit causal inference.
Conclusion : Medicare payments for inpatient spine care exhibit significant racial and ethnic disparities that persist beyond the current Hierarchical Condition Category risk-adjustment model. The opposing directional effects observed between Black and Hispanic populations, combined with substantial regional variations, suggest systematic differences in spine care delivery patterns that may reflect underlying disparities in access, treatment selection, or care coordination. These findings raise important questions about whether existing payment methodologies adequately capture population-level differences in healthcare needs and delivery systems. From a cost containment perspective, understanding these disparities is crucial as they may indicate either systematic underpayment or overpayment for certain populations. Future research should investigate whether these payment variations reflect appropriate adjustments for population needs or represent opportunities to enhance payment equity while maintaining cost efficiency in spine care delivery.