In the rapidly evolving landscape of value-driven health care reimbursement, an increasing number of physicians are opting for outsourced medical billing services to stay financially viable. Such support is especially critical for providers of orthopedic services as recent Medicare reforms for this field include the evolution of bundled payments with mandatory programs such as Comprehensive Care for Joint Replacement (CJR) and Femur Fracture Treatment (SHFFT) and Merit-based Incentive Payment System (MIPS) pay-for-performance, and readmission penalties.
A recent study stresses that orthopedic specialists need to assess factors that warn of good and bad outcomes in patients who undergo total hip arthroplasty (THA) hip replacement. The researchers found that compared to patients without lumbar spine disease who undergo THA, patients with lumbar spine disease who have THA face a higher risk of complications and may have lower chances for potential improvement.
Hip-spine syndrome refers to the concurrent existence of osteoarthritis and degenerative lumbar spine disease. It is estimated that more than 310,000 hip replacements are performed in the U.S. each year and about 2.5 million Americans are currently living with hip replacements.
The researchers used the Pearl Diver Patient Records Database (Pearl Diver Technologies, Fort Wayne, Indiana) to search all Medicare Standard Analytical Files from 2005 to 2012 using ICD-9 codes. The methodology adopted was as follows:
- The database was searched to identify all patients undergoing total hip replacement with and without lumbar spine diseases between 2005 and 2012.
- Demographic data such as age range, sex, and comorbidities present before THA were also collected for each group.
- Initial patient cohorts were identified by the following ICD-9 codes:
- 722.52 – degeneration of lumbar or lumbosacral intervertebral disk
- 722.10 – displacement of lumbar intervertebral disk without myelopathy
- 721.3 – Lumbosacral spondylosis without myelopathy
- 738.4 – Acquired spondylolisthesis
- The control population consisted of all patients without one of the above-mentioned ICD-9 codes
- The cohorts were then cross-referenced with the ICD-9 and THA procedure codes (CPT codes) for medical and surgical complications after THA
- The researchers obtained the rates of complications in the first 30 days, 90 days, 1 year, and 2 years for each lumbar spine disease diagnosis cohort as well as the control group.
The study found that compared with control patients, the risk of medical complications in patients with different lumbar spine diseases increased in almost all diseases at the 90-day follow-up point. The researchers point out the in this era of managed-care and results-driven policies for treatment approval and reimbursement, orthopedic surgeons need to evaluate and discuss potential outcomes with patients prior to THA. This will help to set expectations and measure risk, which is crucial, as through THA can significantly improve quality of life for patients with lumbar spine disease, such patients face “elevated risk of complications and may have a lower ceiling for potential improvement”. Better understanding of risk of complications can guide treatment decisions and research into alternative treatments, protocols, or surgical techniques.
With increasingly complex payment systems, physician practices are facing growing levels of financial risk. When it comes to accurate claim submission for value and quality-driven payments, the best option for orthopedic surgeons is to partner with an experienced medical billing and coding company.