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Recent Studies from Stanford University Add New Data to Medical Devices and Surgical Technology (Widening Gaps in Episode of Care Markers between Medicare Managed Care and Medicare Fee-for-Service in Spinal Fusion): Medical Devices and Surgical Technology

Insurance Daily News

2026 FEB 13 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A new study on Medical Devices and Surgical Technology is now available. According to news reporting originating from Redwood City, California, by NewsRx correspondents, research stated, “Failure to accurately predict length of stay (LOS) and discharge disposition in the setting of spine fusion episodes of care can have substantial impact on patient care and resource allocation. Mandatory upcoming bundled payment models for spinal fusion will focus solely on Traditional Medicare beneficiaries; however, less is known about episode of care metrics in this subgroup compared with patients in other insurance classes.”

Our news editors obtained a quote from the research from Stanford University, “We sought to compare time-based trends among Traditional Medicare ™ and Medicare Advantage (MA) in 1) LOS and home discharge, 2) readmission and emergency department visits, and 3) prevalence of medical comorbidities and social vulnerability. The Epic Cosmos dataset (comprising longitudinal records for over 300 million patients from over 1,700 hospitals) was used for this retrospective cohort study. Episodes of care containing single-level lumbar fusions performed in adults between January 1, 2016, to December 31, 2024. The primary outcome was length of stay in days. Secondary outcomes included rates of discharge home, 30-day readmission rates, and 30-day emergency department visits. Time-based trends and differences among primary insurance classes in LOS were assessed via a negative binomial regression model that included a two-way interaction between primary insurance class and time, with adjustment for sociodemographic, clinical, and institutional covariates. Primary insurance classes included Traditional Medicare, Medicare Advantage, Commercial, and Medicaid. Post-hoc tests were adjusted for multiple comparisons via the Holm-Bonferroni method. Among 126,304 spinal fusion episodes, LOS for TM patients decreased at an adjusted rate of 1.1% [(95% CI 0.4,1.7), p<0.001] faster per year compared with MA (TM: 2016-2024 unadjusted LOS 3.37-2.54; MA 3.53-3.12 days). Between 2016-2024, TM and MA both saw increases in home discharge, however by 2024 MA had higher adjusted rates of home discharge (unadjusted 2016-2024 raw rates TM 77.2-86.8%; MA 76.0-87.9%; adjusted 2024 rate 33% higher than TM [95% CI 18,51%, p< 0.001]). Over the study period, the MA cohort changed to become the group with the greatest number of Hierarchical Conditional Categories (2016 to 2024, 0.45-0.77; 15% increase compared to TM [10%, 22%, p< 0.001]). At the end of the study period, TM and Commercial had similar SVI (unadjusted 50 vs 50 percentile, adjusted p> 0.05) and MA and Medicaid had similar SVI (unadjusted 56 and 63 percentile, adjusted p> 0.05). There were no differences in time-based trends between groups for readmission rates and emergency department visits. We observed longer LOS and increased home discharge rates with Medicare Advantage compared to Traditional Medicare over time without apparent improvements in readmission rates or emergency department visits. Traditional Medicare now has LOS and SVI approximating the commercially insured. The changes demonstrated in this study underscore widening gaps between Traditional Medicare and Medicare Advantage beneficiaries, despite the fact that upcoming mandatory bundled payment models will focus solely on Traditional Medicare beneficiaries. 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 length of stay and increasing denials for post-acute care.”

According to the news editors, the research concluded: “Clinicians play a key role in setting patient expectations at the point-of-care and pre-surgical discharge planning may be important for certain subgroups.”

This research has been peer-reviewed.

For more information on this research see: Widening Gaps in Episode of Care Markers between Medicare Managed Care and Medicare Fee-for-Service in Spinal Fusion. Spine Journal, 2026. Spine Journal can be contacted at: Elsevier Science Inc, Ste 800, 230 Park Ave, New York, NY 10169, USA. (Elsevier - www.elsevier.com; Spine Journal - http://www.journals.elsevier.com/spine-journal/)

The news editors report that additional information may be obtained by contacting Henry Wong, Dept. of Orthopaedic Surgery, Stanford University, Redwood City, California, United States. Additional authors for this research include Alexa K. Pius, Jayme C. B. Koltsov, Serena S. Hu, Andrew J. Schoenfeld and Grace X. Xiong.