Skip to main content

Table 1 Actual, price-standardized, and fully adjusted TRICARE payments during 60-, 90- and 180-day episode lengths for cervical and non-cervical spinal fusion

From: Strategies for spinal surgery reimbursement: bundling in the working-age population

DRG Length of Bundle Method of Cost Calculation Quintile Difference* (% of 1st Quintile)
1 2 3 4 5
Cervical 60 day bundle Actual $16,012 $17,760 $19,118 $21,512 $29,136 $13,124 (82%)
Price-Standardized $16,671 $18,084 $19,203 $21,341 $27,562 $10,891 (65%)
Price Standardized + Casemix Adjusted $16,728 $18,059 $19,112 $21,236 $27,281 $10,553 (63%)
90 day bundle Actual $16,677 $18,472 $19,929 $22,420 $30,259 $13,581 (81%)
Price-Standardized $17,389 $18,865 $20,061 $22,166 $28,532 $11,143 (64%)
Price Standardized + Casemix Adjusted $17,459 $18,804 $19,960 $22,077 $27,997 $10,538 (60%)
180 day bundle Actual $18,575 $20,560 $22,426 $24,884 $33,528 $14,953 (81%)
Price-Standardized $19,483 $20,949 $22,616 $24,550 $31,129 $11,646 (60%)
Price Standardized + Casemix Adjusted $19,570 $20,880 $22,309 $24,377 $30,261 $10,691 (55%)
Non-cervical 60 day bundle Actual $25,879 $29,324 $32,028 $35,551 $49,211 $23,331 (90%)
Price-Standardized $27,130 $29,915 $32,337 $35,341 $46,942 $19,812 (73%)
Price Standardized + Casemix Adjusted $26,617 $29,722 $32,083 $34,927 $46,784 $20,168 (76%)
90 day bundle Actual $26,566 $30,128 $32,952 $36,573 $50,734 $24,167 (91%)
Price-Standardized $27,955 $30,750 $33,237 $36,139 $47,640 $19,685 (70%)
Price Standardized + Casemix Adjusted $27,410 $30,661 $33,063 $35,894 $47,565 $20,156 (74%)
180 day bundle Actual $28,737 $32,614 $35,553 $39,436 $54,443 $25,705 (89%)
Price-Standardized $30,216 $33,420 $35,870 $38,995 $50,706 $20,490 (68%)
Price Standardized + Casemix Adjusted $29,625 $33,143 $35,622 $38,317 $50,045 $20,420 (69%)
  1. *Difference reflects the variation between highest and lowest quintiles, shown as a dollar value and as a percentage of the lowest quintile value
\