Student Johns Hopkins School of Medicine Baltimore, Maryland, United States
Introduction: Sacroiliac (SI) joint dysfunction constitutes a leading cause of lower back pain and disability. Patients with pain refractory to conservative treatments can benefit from surgical fusion. Although traditionally performed under open approaches, the past decade has seen a rise in minimally invasive surgical (MIS) techniques and new federally approved devices for MIS approaches. There procedures are performed by neurosurgeons, orthopedic surgeons and clinicians from other specialties. Here we describe trends in the number of SI joint fusions performed by different provider groups, along with the charges billed and reimbursement provided by Medicare.
Methods: We queried the Centers for Medicare and Medicaid Services’ Physician/Supplier Procedure Summary yearly data sets from 2015 to 2020 for all open and MIS SI joint fusions. Surgeries were classified as performed by neurosurgeons/orthopedic surgeons or clinicians from other specialties. Utilization was adjusted per million Medicare beneficiaries and weighted averages for charges and reimbursements were calculated, controlling for inflation. Reimbursement-to-charge (RCR) ratios were calculated, reflecting the proportion of provider billed amounts reimbursed by Medicare.
Results: MIS procedural utilization increased by 41.9 (254%) cases per million beneficiaries over the study period, with rapid growth noted for all specialties. MIS cases per million beneficiaries performed in the outpatient setting increased by 642% while declining by 32% in the inpatient setting. Most MIS procedures were performed by clinicians from specialties other than neurosurgery and orthopedic surgery, while most open fusions were performed by neurosurgeons and orthopedic surgeons. The overall RCR increased by 19% to 0.27, with neurosurgeons and orthopedic surgeons having a similar RCR as other specialties (0.26 and 0.27, respectively). However, the RCR increased by 293% for other specialties over the study period compared to 20% for neurosurgeons and orthopedic surgeons.
Conclusion : Substantial growth in the number of MIS procedures performed has occurred over the past decade in the Medicare population. Increasingly, SI joint fusions are performed in a minimally invasive manners by clinicians who are not trained in neurosurgery or orthopedic surgery. Future studies may be warranted to better understand the impact of these trends on patient outcomes and healthcare costs.
