Work

Dual-Eligible Patient Burden Is Independently Associated With Lower Standardized Reimbursement Among Lumbar Laminectomy Surgeons: A National Medicare Analysis

Year: 2026

Type: article

Abstract: Study DesignRetrospective cross-sectional analysis of a national Medicare administrative dataset (2023).ObjectivesDual eligibility for Medicare and Medicaid is an established marker of socioeconomic vulnerability, but its association with surgeon reimbursement is uncharacterized in the lumbar laminectomy market. We evaluated whether surgeon-level dual-eligibility proportion is associated with laminectomy volume and standardized reimbursement.MethodsSingle-level lumbar laminectomy surgeons were identified by CPT code 63047 in the 2023 Centers for Medicare and Medicaid Services (CMS) Physician and Other Practitioners file. Dual-eligibility proportion, the share of dual-eligible beneficiaries in each surgeon's Medicare panel, was categorized into quartiles. Outcomes were laminectomy volume and mean standardized reimbursement per procedure; panel comorbidity, minority composition, behavioral health diagnoses, and rurality were also assessed. Quartile and multivariable analyses were restricted to the 3,075 surgeons (73.7%) with complete panel data.ResultsWe identified 4,170 surgeons performing 102,006 procedures. Higher dual-eligibility proportion was associated with lower standardized reimbursement (Q1, $672.81 vs. Q4, $502.53), greater beneficiary risk (Hierarchical Condition Category score, 1.11 vs. 1.38), higher minority panel composition, and more anxiety (28.88% vs. 34.21%) and depression (26.00% vs. 32.30%); all P < 0.001. Each 1-percentage-point increase in dual-eligibility proportion was independently associated with $5.68 lower standardized reimbursement (β = -5.676; 95% CI, -7.75 to -3.60; P < 0.001).ConclusionsSurgeons who disproportionately serve dual-eligible beneficiaries receive lower standardized reimbursement despite treating more medically and psychosocially complex patients. Because analyses required complete CMS panel data, estimates may not generalize to lower-volume or rural providers.

Source: Global Spine Journal

DOI: 10.1177/21925682261498031

Authors: Alexander Kucherina, Steven Govinda Persaud, Paul Mastrokostas, Charla Fischer

Institutions: NYU Langone Health, Weill Cornell Medicine, SUNY Downstate Health Sciences University

Language: English

Topic: Healthcare Policy and Management

Subfield: Economics and Econometrics

Field: Economics, Econometrics and Finance

Domain: Social Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $2,650