Primary Cervical Disc Arthroplasty Among Medicare Beneficiaries Versus Alternative Payers: Is It Time to Consider Nationwide Coverage?

Study Design: Retrospective cohort study.

Objectives: As of 2022, the Centers for Medicare and Medicaid Services does not provide nationwide coverage for cervical disc arthroplasty (CDA). The aim was to determine whether Medicare beneficiaries have differences in: (1) lengths of stay (LOS); (2) complications; (3) readmissions; and (4) costs of care.

Methods: Using the 2010 to 2020 PearlDiver database, we queried patients undergoing primary CDA for degenerative disc pathology. Study groups patients were those undergoing CDA with Medicare coverage (n = 1467); patients without Medicare coverage were the comparison cohort (n = 15,389). Endpoints were to compare demographics and comorbidities within the Elixhauser comorbidity index (ECI), LOS, 90-day complications, 90-day readmissions, and 90-day reimbursements. A multivariate logistic regression was used to calculate odds (OR) of medical complications and readmissions within 90-days. A -value less than .003 was significant.

Results: Patients with Medicare coverage undergoing CDA had higher mean ECI compared to alternative payers (5.24 vs 3.26; < .0001). Mean LOS was significantly higher for Medicare beneficiaries (2.20 vs 1.76 days; < .010). There was no significant differences in odds of all medical complications (OR: 1.19, 95% CI: .98-1.44; = .069) or readmission rates (1.77% vs 1.33%, OR:0.82, 95% CI: .50-1.29; = .417) within 90-days following the index procedure among Medicare beneficiaries vs alternative payers. Non-Medicare beneficiaries had higher 90-day reimbursements compared to Medicare beneficiaries ($6,700 vs $7,086, < .001).

Conclusions: Medicare beneficiaries despite having slightly longer lengths of stay did not have higher rates of medical complications or readmissions. Surgeons and policy makers may use this data to consider alternative treatments in Medicare patients.