Ninety-Day Bundled Payment Reimbursement for Patients Undergoing Anterior and Posterior Procedures for Degenerative Cervical Radiculopathy

Ahmad Alhourani, Mayur Sharma, Beatrice Ugiliweneza, Dengzhi Wang, Miriam Nuño, Doniel Drazin, Maxwell Boakye

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Anterior cervical discectomy with fusion (ACDF) or posterior cervical foraminotomy (PCF) are the mainstay surgical treatment options for patients with degenerative cervical radiculopathy (DCR). OBJECTIVE: To compare 90-d bundled payments between ACDF and PCF for DCR in a cohort study. METHODS: Data were extracted from MarketScan database (2000-2016) using ICD-9, ICD-10, and CPT-4 codes. The bundle payments were calculated as the payments accumulated from the index hospitalization admission to 90 d postsurgery. We also analyzed the index hospitalization (physician, hospital, and total) and the postdischarge payments (hospital readmission, outpatient services, medications, and total). Surgical groups were matched based on baseline characteristics (age, sex, insurance type, and Elixhauser score). RESULTS: A total of 100 041 patients met the inclusion criteria. 94.9% of patients (n = 95 031). Patients underwent ACDF with 5.1% (n = 5 010) treated via PCF. Overall, median 90-d costs were significantly higher for ACDF than for PCF ($31567 vs $18412; P <. 0001). The median total index hospitalization ($27841 vs $15043), physician ($4572 vs $1920), and hospital payments ($14540 vs $7404) were higher for ACDF compared to PCF for both single-and multiple-level cohorts (P <. 0001). There was no difference in overall 90-d postdischarge payments. Factors associated with higher 90-d payments for both cohorts included age and comorbidity scores. CONCLUSION: ACDF is associated with greater bundle payments in patients diagnosed with DCR. No difference was noted for the total postdischarge payments. PCF may be a cost-effective surgical option in appropriately selected patients with unilateral, paracentral, and foraminal soft herniated discs.

Original languageEnglish (US)
Pages (from-to)E851-E859
JournalClinical Neurosurgery
Issue number5
StatePublished - Nov 1 2019


  • Anterior cervical procedures
  • Bundle payment
  • Degenerative cervical radiculopathy
  • Posterior cervical procedures

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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