Association Between Physician Industry Payments and Cost of Anterior Cervical Discectomy and Fusion in Medicare Beneficiaries

Caterina Liu, Karim Ahmed, Catherine L. Chen, R. Adams Dudley, Ralph Gonzales, Katie Orrico, Ketan Yerneni, Martin N. Stienen, Anand Veeravagu, Atman Desai, Jon Park, John K. Ratliff, Corinna C. Zygourakis

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Background: Neurosurgical spine specialists receive considerable amounts of industry support that may impact the cost of care. The aim of this study was to evaluate the association between industry payments received by spine surgeons and the total hospital and operating room (OR) costs of an anterior cervical discectomy and fusion (ACDF) procedure among Medicare beneficiaries. Methods: All ACDF cases were identified among the Medicare carrier files from January 1, 2013, to December 31, 2014, and matched to the Medicare inpatient baseline file. The total hospital and OR charges were obtained for these cases. Charges were converted to cost using year-specific cost-to-charge ratios. Surgeons were identified among the Open Payments database, which is used to quantify industry support. Analyses were performed to examine the association between industry payments received and ACDF costs. Results: Matching resulting in the inclusion of 2209 ACDF claims from 2013–2014. In 2013 and 2014, the mean total cost for an ACDF was $21,798 and $21,008, respectively; mean OR cost was $5878 and $6064, respectively. Mann-Whitney U test demonstrated no significant differences in the mean total or OR cost for an ACDF based on quartile of general industry payment received (P = 0.21 and P = 0.54), and linear regression found no association between industry general payments, research support, or investments on the total hospital cost (P = 0.41, P = 0.13, and P = 0.25, respectively), or OR cost for an ACDF (P = 0.35, P = 0.24, and P = 0.40, respectively). Conclusions: This study suggests that spine surgeons performing ACDF surgeries may receive industry support without impacting the cost of care.

Original languageEnglish (US)
Pages (from-to)e574-e580
JournalWorld neurosurgery
StatePublished - Nov 2020

Bibliographical note

Funding Information:
Conflict of interest statement: This project was supported by the Caring Wisely Program , a joint effort of UCSF Health and the UCSF Center for Healthcare Value. CCZ was supported by a fellowship from the UCSF Center for Healthcare Value . The funding sources had no direct role in development of this paper. Disclosures: CCZ (consultant: SpineAlign and Globus), AV (consultant: Nuvasive, Johnson and Johnson, and Surgical Theater), AD (consultant, Depuy Synthes), JR (consultant: Stryker Spine, Nuvasive, Medtronic; grant funding: Agency for Healthcare Research and Quality ). All other authors have no disclosures to report.

Publisher Copyright:
© 2020 Elsevier Inc.


  • ACDF
  • Anterior cervical discectomy and fusion
  • Claims
  • Health care costs
  • Industry
  • Medicare


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