Good morning. My name is Kent Richter. I'm a third-year medical student at Mayo Clinic Alex School of Medicine. I'd like to sincerely thank the AANS for allowing us to present our work today at the Young Neurosurgeons Research Forum in this virtual format, and I'd like to thank my colleagues Jack Hagelin, Jordan Pollock, and Dr. Nirish Patel, whose hard work and support made this project possible. Authors have nothing to disclose. The purpose of our study was to evaluate monetary trends in Medicare reimbursement for implantable spinal cord stimulators between 2000 and 2019. Just a little bit of a background. Back pain is a major issue in the United States. It's estimated that around 65 million Americans report a recent episode of back pain, and that 16 million of these suffer from back pain to such an extent where it affects the everyday quality of their lives. Healthcare costs and indirect costs due to back pain have been estimated to be over $12 billion per year. There are a variety of procedures and devices designed to improve back pain depending on the ideology of the pathologic process, and one such device is the implantable spinal cord stimulator. Before we really get into reimbursement for spinal cord stimulators specifically, I wanted to discuss Medicare reimbursement generally. So Medicare currently reimburses physician services via a structured annually updated fee schedule, and all procedures reimbursed by Medicare have a specific current procedural terminology code or CPT code. Payment is based upon relative value units, which are a summation value of value units allocated for work, expense, and malpractice for each procedure. This summed RVU is then multiplied by a geographic modifier, and this value is then again multiplied by a standardized conversion factor to convert the value units into a monetary reimbursement rate. As policy surrounding healthcare spending has vastly changed throughout the last 20 years, it's important to evaluate trends in Medicare reimbursement in neurosurgery throughout this time period. For this analysis, we focused on the top three most common procedures associated with spinal cord stimulators. These three procedures are listed in the following table. For each procedure, the physician schedule lookup tool for the CMS was queried. This database provides Medicare reimbursement fees for each procedure for each year between 2000 and 2019. Policy information for each procedure was collected for all Medicare administrative contractor options and modifiers, and each geographic iteration of the reimbursement was averaged to reflect a comprehensive reimbursement for each procedure. So change in reimbursement was calculated and analyzed between the years 2000 and 2019. So here are the three most common CPT codes related to spinal cord stimulators. These CPT codes are the following, 63650, which is percutaneous implantation of neurostimulator electrode, 63655, laminectomy for implantation of neurostimulator electrodes plate or paddle, and 63685, insertion or replacement of spinal neurostimulator pulse generator or receiver. So the raw percentage change in Medicare reimbursement rate from 2000 to 2019 was calculated for each procedure and was then averaged. This was then compared to the percent change in the consumer price index over that same time. As demonstrated in the table above, raw unadjusted reimbursement rates for CPT codes decreased overall by 7.93%, while the average CPI increased by 46.7%. After adjusting all reimbursement data for inflation, the average reimbursement for included procedures decreased by an average of 37.26% between 2000 and 2019. Code 63650, or percutaneous implantation of neurostimulator electrode array, decreased by 37.63%. Code 63655, excuse me, laminectomy for implantation of neurostimulator electrodes plate or paddle decreased by 24.87%. And then finally, code 63685, insertion or replacement of spinal neurostimulator pulse generator or receiver decreased the most by 49.28%. So just to recap, total raw reimbursement rate decreased on average by 7.93% across all procedures from 2000 to 2019, and this was significantly lower than the rate of change to the consumer pricing index over the same time, which increased by 46.7%, indicating that reimbursement obviously has not kept up with inflation. When the data is adjusted to 2019 dollars, the average reimbursement across all included procedures declined by 37.26%. So what are the implications of these findings? In conclusion, after adjusting for inflation, Medicare reimbursement rates for spinal cord stimulators have steadily and dramatically decreased from 2000 to 2019. And consideration of these trends is important as hospitals and physicians continue to provide palliative care for patients who suffer from chronic back pain. Thank you all very much for your attention and stay safe and be well during this COVID crisis. Thank you.

Kent Richter

medical student

Mayo Clinic Alex School of Medicine

Medicare reimbursement

implantable spinal cord stimulators