Many Patients Lack Understanding of Spine Surgery Reimbursement

Commentary by K. Linnea Welton, MD and Christopher Bono, MD

Patients who undergo spine surgery often overestimate the amount of reimbursement their surgeons receive for the procedures, according to a study in the November 1 issue of The Spine Journal.

Insurance coverage“Two of the most important points from this study are that 1) it demonstrates to the public and policymakers the high value that patients place on surgeons who perform positive, life-altering procedures, and 2) that there exists a significant knowledge gap not only about how payment is allocated in medical reimbursement, but also with general health care principals,” commented lead author K. Linnea Welton, MD, Resident Surgeon in the Department of Orthopaedic Surgery at the University of Michigan, Ann Arbor, MI.

The researchers mailed a 12-question survey about insurance reimbursement to 385 patients who recently underwent spine surgery. A total of 103 patients (27%) responded to the survey. Approximately three-quarters of the patients underwent a major spine surgery (ie, cervical fusion, lumbar fusion, or laminectomy with fusion) and the remaining one quarter underwent minor procedures (ie, kyphoplasty, discectomy, or laminectomy without fusion).

Majority of Patients Overestimated Reimbursement for Orthopedic Surgery
Of the patients who underwent a major surgery, 28% overestimated the amount of insurance reimbursement for their procedure by more than $8,000 more than the actual reimbursement (P<0.05 for both Medicare and private insurance). For minor surgery, 62% of patients estimated that the surgeon’s reimbursement was between $5,000 and $10,000, while highest reimbursement received actually ranged from $1,363 from Medicare and $2,038 from a private insurance company. This difference between patients’ perceived reimbursement and actual reimbursement was statistically significant (P=0.0023 for Medicare and P=0.0026 for private insurance).

Most respondents also believed that surgeons were paid extra for care in the immediate postoperative period (32.4%) and for postoperative clinic visits (74%), when the cost was actually built into the initial fee for surgery. In addition, 67% respondents were either unsure or believed that surgeons were compensated from device manufacturers for use of implants.

Furthermore, 73% of respondents felt that spine surgeons were appropriately compensated, while 24% thought the surgeons were underpaid and 3% thought surgeons were overpaid.

Lead Author Calls for a More Transparent Health Care System
“While physicians and orthopaedic surgeons, for example, have seen significant reductions in reimbursement to assist in curbing healthcare costs, I believe this study implicates that patients would not agree with this as a continuing part of the solution,” Dr. Welton said. “The majority of respondents consistently overestimated by several fold what surgeons were getting reimbursed and yet felt that they were compensated appropriately or not enough. Instead, perhaps focusing on the costs associated with pharmaceutical and implant/medical device companies would be more pertinent.”

The findings “also drive home the need for having a more transparent health care system. The quality of health care would likely improve if there is greater understanding among the public of how the system works,” Dr. Welton said.

Expert Says Findings Are Not Surprising
Commenting on the study, Christopher Bono, MD, President of the North American Spine Society, said he is not surprised by the findings. “In my own experience, patients, more often than not when looking at their hospital bills, were surprised at how low the surgeon payments were. This was in contrast to how high facility/hospital fees were. This is consistent with what the Welton et al group found.”

Dr. Bono added that a key finding from the study is that many patients believed that their surgeons’ treatment decisions were related to their insurance status. “While it was not the majority, about 33% of patients did feel that this was a factor.”

“In this group of patients, which may be difficult to identify, their outcomes may be impacted based on their impressions of their surgeon,” said Dr. Bono, who also is Associate Professor of Orthopaedic Surgery at Harvard Medical School and Chief of the Orthopaedic Spine Service at Brigham and Women’s Hospital, both in Boston, Mass. “If a patient, for instance, has an unfavorable or less than ideal outcome, and he or she is under the impression that they might have undergone a greater (or lesser) procedure based on their insurance coverage, this would certainly influence the patient-surgeon relationship and subsequent reporting of clinical outcomes. In an age in which collecting patient-reported outcomes is soon to be mandated, these data can have significance.”

Updated on: 01/27/16
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