Introduction: The Affordable Care Act has improved access to healthcare reducing uninsured from 20% in 2010 to 12% in 2016 through Medicaid expansion and the formation of subsidized healthcare insurance exchanges. Additionally, an emphasis on quality of care and reducing cost was placed on providers and insurers through provisions such as medical loss ratios and value based modifiers. It is unclear how the law has affected physician reimbursement in spine surgery. Our objective is to outline the current trends in reimbursement for spine surgery by insurer and spine area over the last 7 years.

Methods: We collected charge data and payment received for all claims from the beginning of 2010 to the end of 2016 related to spine using all CPT codes related to spinal procedures. Payments received per each CPT code were used in the analysis. Payments were then categorized by insurer including Medicare, Medicaid, Private Insurer, and WC/NF. The most common CPT codes were then used to subcategorize by spine area including Thoracolumbar, Cervical, Functional, Grafting, and Injections. Claims were adjusted for inflation of medical care in the Northeast region using the consumer price index.

Results: Yearly average payment after adjusting for inflation of medical care in the northeast area for all spine claims decreased by 13% from 2010 to 2016, p<.0001. Average reimbursement declined 25% from 2010-2013 (p<.0001) and rose 3% from 2014-2016 (p=.2100). Similar trends were seen among each insurer except for Medicaid which increased 8% from 2010-2016 (p=.6708). Payments for the most common thoracolumbar procedures declined by 17% from 2010-2016 (p=.0004). Similar injections declined 19% during that time period (p<.0001) while cervical, functional and grafting procedures had no significant change.

Conclusions: Since the Affordable Care Act was passed in 2010 total yearly average spine reimbursement has declined. The decline occurred primarily form 2010-2013 with increases occurring from 2014 to 2016 but not back to pre-ACA payments after adjusting for inflation. Many of the key provisions in the Affordable Care Act were implemented in 2014. Further analysis of national trends is needed to confirm the results in our area in New York.

Patient Care: AS physicians we should be able to recognize the overall impact political climate can have on patient outcomes and our own practice. With trends in payers and lack there of, physicians can refocus efforts where there is a higher demand for healthcare. With better bargaining power with insurers and better payments, efforts for newer technology and techniques can be used potentially improving patient care.

Learning Objectives: By the conclusion of this session, participants should be able to 1. describe the overall reimbursement in spine surgery in western new York. 2. Be able to describe the similar trends by insurance type and spinal area. 3. Realize the need for future study in reimbursement and importance of political climate in overall reimbursement trends.

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