Introduction: Traditionally, deep brain stimulation (DBS) for Parkinson’s disease has been completed as a two stage procedure. During one surgery, the pulse generator and lead extensions was implanted with the patient under general anesthesia. Implanting the stimulator leads in an awake patient during a separate procedure allowed for clinical observation to supplement earlier, less accurate stereotactic localization and microelectrode recording techniques. Recent technological advances allow surgeons to complete lead placement safely and effectively in patients under general anesthesia using intraoperative image guidance systems or with a combination of standard frame based localization and intraoperative microelectrode recording. Now that both stages of the procedure can be completed while patients are under general anesthesia, it is feasible for the entire DBS system to be implanted during a single, streamlined procedure.
Methods: Review of current literature regarding asleep DBS for Parkinson’s Disease and Medicare reimbursement for DBS.
Results: Unfortunately, current Medicare reimbursement provides a disincentive to physicians and hospitals to complete DBS system implantation during a single surgery. Providers receive an average of $22,423.84 to complete implantation of an entire system during a single procedure. However, providers receive $13,483.47 and $26.152.16 for lead implantation and pulse generator implantation, respectively, when completed as two separate procedures for a total of $39,635.63. Although the single stage operation would save on hospital costs, it is not enough to make up the difference of $17,211.79. In fact, the difference in reimbursement would likely result in hospitals losing money every time a streamlined DBS implantation were completed.
Conclusions: Total DBS system implantation during a single surgery for patients under general anesthesia is now possible using new technology and techniques. Although it would be a more desirable option for patients and a more cost-effective option, reimbursement issues may prove to be a hindrance to surgeons wanting to offer this new treatment option.
Patient Care: Raise awareness for a new treatment option and potential financial hindrances to extending this option to patients
Learning Objectives: 1)Understand the reasoning behind traditional techniques for deep brain stimulation for Parkinson's Disease
2)Understand that deep brain stimulation may now be completed in a single procedure for patients with Parkinson's Disease using new techniques
3) Realize that current reimbursement strategies may provide a disincentive to streamlining deep brain stimulation into a single-stage procedure
References: 1) Medtronic Website - Coding and Coverage. http://professional.medtronic.com/
2) Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson’s disease. Ostrem et. al. Journal of Neurosurgery. Posted online 10/23/15.
3) Parkinson’s disease outcomes after intraoperative CT-guided “asleep” deep brain stimulation in the globus pallidus internus. Mirzadeh et. al. Journal of Neurosurgery. Posted online 10/9/15.