Analysis of surgeon hourly earnings for commonly performed spinal surgeries in Medicare patients: When is a spine surgeon paid less than a Veterinarian?

2014

Purpose
Medicare reimbursement has increased 3% over the past 10 years while the cost of providing care has risen more than 20% is causing some surgeons to question their ability to care for these patients. We examined surgeon reimbursement/hour work under Medicare for common surgeries performed for degenerative disease and adult scoliosis. Surgeon hourly pay was compared to other professions.

Methods
Hospital data was reviewed for all patients undergoing 4 common surgeries by 10 surgeons during 2012: 1) 1 level laminectomy; 2)1 level posterior spinal fusion (PSF) and TLIF; 3) 2 level PSF/1 level TLIF; 4) anterior cervical discectomy/fusion/plating (ACDFP). Three types of scoliosis surgery were also reviewed: 1) Small Degen Scoliosis (SDS) - 3 level laminectomy(lami) + posterior spinal fusion (PSF) L2-5; 2) Adult Idiopathic scoliosis (IS) - PSF T4-L4; 3) Large Degen Scoliosis (LDS) - PSF T11-S1+ 3 level lami + 1 level TLIF. Time spent in patient care included in the global fee (preop discussion, intubation, positioning, surgery, dictation, family discussion, rounding time, postop visits at 2, 6, 12 wks) and additional billable care (surgical consult, pre-op visit, postop visits at 6,9,12 mo) were recorded. The total hrs spent in surgeon-provided care was divided by Medicare reimbursements to obtain $/hr surgeon payment for each surgery, and adjusted by a range of practice overhead (40%, 50%, 60% and 70%).

Results
Operative times: lami- 2.1 hrs (1.4-3.4hrs), PSF/TLIF- 2.8 hrs (2.1-4.0hrs), 2 level PSF/TLIF- 3.7 hrs (2.1-5.6hrs), ACDFP- 2.3 hrs (1.5-3.3hrs) SDS-5.6 hrs (5.0-6.1hrs), IS–5.7 hrs (4.5-8.5hrs), LDS–6.9 hrs (5.0-8.3hrs). Hospital length of stay: Lami- 1 day (1-3days), PSF/TLIF- 3 days (1-5days), 2 level PSF/TLIF- 3 days (1-6days), and ACDFP- 1 day (1-2days), SDS–5.75 days(4-8days), IS-5.6 days(4-9days), LDS–6.1 days(4-9days). Total care time: Lami- 8.85 hrs, PSF/TLIF- 10.58 hrs, 2 level PSF/TLIF - 11.42 hrs, ACDFP - 7.82 hrs, SDS-12.65 hrs, IS–12.81 hrs, LDS-14.26 hrs. None of these surgeries paid spine surgeons equal to average neurosurgeon or orthopedic surgeon pay per hour. See table for reimbursement results.

Conclusions
Medicare reimbursement impacts the economic viability of many surgical practices, in some cases paying the surgeon less than a veterinarian and similar to a Physician Assistant. Spine surgeons must become creative in order to earn what average orthopedic and neurosurgeons make.