Lumbar Disc Replacement in Medicare Beneficiaries: Assessment of Regional Distribution and Financial Outcomes of Medicare Beneficiaries Undergoing Lumbar Disc Replacement Versus Lumbar Spinal Fusion
Postdoctoral Research Fellow Mayo Clinic Rochester Rochester, MN, US
Disclosure(s):
Asimina Dominari, MD: No financial relationships to disclose
Introduction: Lumbar disc replacement (LDR) has been characterized as not medically necessary in patients over 60 years old, while for Medicare beneficiaries sixty years of age and under, there is no national coverage determination, leaving such determinations to be made on a local basis.
Methods: The Medicare Claims Database was queried to identify cases of LDR, and lumbar fusion treated in 2018. Patient demographics and baseline characteristics, clinical outcomes, as well as cost- and payment-related parameters were compared among patients who underwent LDR versus lumbar fusion.
Results: A total of 38 patients who underwent LDR, and 20,984 patients who underwent lumbar fusion were identified. Patients undergoing LDR were significantly more likely to receive Medicare coverage due to disability compared to patients undergoing lumbar fusion (31.6% vs. 16.1%, p=0.03). The non-covered charges amount was significantly higher among patients who underwent LDR compared to patients who underwent lumbar fusion ($31,904.1 ± 154,598.5 vs. 1,687.9 ± 21,622.1, p < 0.001). The total charges amount for all claim-related services was $193,445.2 ± 193,519 among patients who underwent LDR, and $157,556.7 ± 131,663.9 among patients who underwent lumbar fusion (p=0.09). No significant differences were additionally noted between the LDR and lumbar fusion groups with respect to the number of days of care covered (3.6 ± 3 vs. 3.7 ± 3.5, p=0.8) or the proportion of cost outliers (13.2% vs. 9.5%, p=0.4). Lastly, the regional distribution of LDA and lumbar fusion cases did not significantly differ depending on the U.S. State (p=0.8), Division (p=0.5), or Region (p=0.8) in which the patient encounters took place.
Conclusion : In this study assessing the financial outcomes and regional distribution of LDR cases within Medicare, we found that only 38 patients underwent LDR compared to over 20,000 cases of lumbar fusion over a one-year period. In addition, the non-covered healthcare costs of patients who underwent LDR were significantly higher compared to the non-covered costs of patients who underwent lumbar fusion, highlighting the absence of a nationwide strategy for LDR coverage in Medicare beneficiaries.