The aim of the study was to compare 90-day and 2-year reimbursements for more than or equal to 2-level anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), posterior laminectomy and fusion (LF) and laminoplasty (LP) done for degenerative cervical myelopathy (DCM). For DCM diseases with clinical equivalence in approach selection, a randomized controlled experiment indicated that an anterior approach did not significantly improve patient-reported outcomes compared to posterior methods. When making choices in the age of value and bundled payments, the cost profile of potential methods is crucial. IBM MarketScan Research Database (2005–2018) was used to study beneficiaries (30–75 y) who underwent surgery (mACDF, ACCF, LF, LP) for DCM. Amounts for the index hospital stay (operative room, surgeon, hospital services), as well as post-discharge inpatient, outpatient, and prescription medicine costs, have been modeled to represent the 90-day and 2-year bundled payment amounts, and their distribution, for each treatment. The median age of the 10,834 patients who participated was 54. The median 90-day payment was $46,094 (interquartile range: $34,243–$65,841) for all procedures, with LF being the highest ($64,542) and LP the lowest ($37,867). Index hospital was 62.4% (operating room: 46.6), and surgeon payments were 17.5% of the average 90-day bundle. The index reimbursement, the 90-day reimbursement, and the 2-year reimbursement were significantly different from 1 another and from 1 procedure to the next. LP had the lowest complication rate and the highest simulated bundled reimbursements at 90 days and 2 years postoperatively in a national cohort of patients receiving surgery for DCM. The 90-day payout for LF in the lowest quartile was greater than the mACDF, ACCF, and LP medians combined. Maximum benefit can be expected from LP if surgeons encounter real-world settings involving clinical equipment, as it is 70% less expensive than LF over a 90-day period. 

Source: journals.lww.com/jspinaldisorders/Abstract/2022/10000/Simulated_Bundled_Payments_for_4_Common_Surgical.5.aspx