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Medicaid Pays 75 Percent of What Medicare Pays for Spine Surgeries

Study authors report differences in reimbursement for certain procedures may impact access to care

FRIDAY, Oct. 4, 2019 (HealthDay News) — There are large disparities between Medicaid and Medicare reimbursement rates for eight spine procedures, according to a study published online Sept. 26 in Spine.

David S. Casper, M.D., from the Rothman Institute at Thomas Jefferson University in Philadelphia, and colleagues examined online data to compare differences in reimbursement for eight spine procedures between Medicaid and regional Medicare rates.

The researchers found that the average Medicaid reimbursement was 78.4 percent of that for Medicare. There was significant Medicaid variation between states (38.8 to 140 percent of Medicare for the combined eight procedures). Twenty states provided <75 percent of Medicare reimbursement and 42 states provided 100 percent depending on the procedure. New York, New Jersey, Florida, and Rhode Island, on average, provided Medicaid reimbursements < 50 percent of regional Medicare reimbursements. Medicaid appears to value microdiscectomy (84.1 percent of Medicare) over other elective spine procedures; however, microdiscectomy had the most interstate variation in Medicaid reimbursement (39 to 207 percent of Medicare).

“Further research is necessary to fully understand the impact of these significant differences,” the authors write. “However, it is likely that these discrepancies lead to suboptimal access to necessary spine care.”

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