Insurance Coverage Impacts Episode of Care for Spinal Fusions

Key Takeaways:

• Among the patients who underwent lumbar fusions, those with Medicare Fee-For-Service (FFS) had decreased lengths of stay (LOS) compared to those with Medicare Advantage.
• Both Advantage and FFS beneficiaries had increases in home discharges from 2016 to 2024, but the rate was higher for Advantage patients.
• Upcoming bundled payment models designed only for FFS beneficiaries could further widen the gap between these cohorts and affect care access and patient satisfaction.

Hospital LOS and discharge can significantly affect care for patients undergoing spinal fusions. Insurance type may impact episode of care, possibly decreasing patient satisfaction and straining hospital resources.

The upcoming Transforming Episode Accountability Model (TEAM) through Medicare will include all costs from the initial surgery through 30-day post-acute care. However, this bundled payment model will only be available for Medicare FFS beneficiaries.

Considering how many Medicare beneficiaries are enrolled in Medicare Advantage, limiting TEAM could widen gaps in care coverage.

Researchers compared the episodes of care among adults with Medicare Advantage and Medicare FFS who underwent lumbar fusions between January 2016 and December 2024. They observed LOS and home discharge, 30-day readmission and emergency department (ED) visits, and social vulnerability.

Medicare Advantage vs Medicare FFS

Among the 126 304 spinal fusion episodes included in the study, patients with FFS had shorter LOS than patients with Advantage. From 2016 to 2024, LOS decreased from 3.37 to 2.54 days for FFS and from 3.53 to 3.12 days for Advantage.

Although both cohorts experienced increases in home discharge, the rate was higher for patients with Advantage than for those with FFS, with Advantage patients having a 33% higher home discharge rate in 2024 than FFS patients.

Advantage and FFS had similar social vulnerability indexes (SVI), 56th and 50th percentile, respectively.

No differences were observed between groups for hospital readmissions and ED visits.

Implications for Managed Care

Patients with Medicare Advantage had longer LOS and higher home discharge rates compared to patients with Medicare FFS. These results highlight the disparities between these cohorts, and these gaps may continue to expand with the implementation of payment models focused solely on FFS beneficiaries.

The researchers noted, “As [Medicare Advantage] becomes the dominant insurance class in the geriatric population, spine surgeons should be aware of patterns specific to [Medicare Advantage] patients, such as prolonged LOS and increasing denials for postacute care.”

Reference

Pius AK, Wong H, Koltsov JCB, Hu SS, Schoenfeld AJ, Xiong GX. Widening gaps in episode of care markers between Medicare managed care and Medicare fee-for-service in spinal fusion. Spine J. 2026. doi:10.1016/j.spinee.2026.01.022