ORA: 11092015-IRB01 Date IRB Approved: 10/21/2011 Expiration Date: 10/21/2012 Amendment Date: 11/16/2011

Title of Study:Patient Perception of Physician Reimbursement in Spine Surgery

What is involved in the study?

The goal of this research study is to measure the difference between what patients’ perceive the costs

of spinal surgery are and compare this to actual reimbursement. Participation in this study will involve only the completion of the enclosed questionnaires. These questionnaires are kept anonymous. Your responses will not be known to your doctor - you will receive the same care from your doctor whether or not you choose to participate in the survey. We realize that you may not have any idea what doctors get paid. Please make your best guess when answering the questions. There are no right or wrong answers!

Once you fill out the survey, place it in the enclosed envelope and present to the receptionist in the clinic. This indicates your willingness to participate in this study. There will be no requirements for you

beyond the completion of the questionnaire.

Research studies include only people who choose to take part. Remember that your participation is

completely voluntary. There is no penalty if you decide not to take part in this study or decide later that

you want to stop participating in this survey. Your care at Rush University Medical Center will not be

affected if you decide not to participate.

What will you be asked to do?

Subjects, who are considering spine surgery or visiting their surgeon after their surgery at Rush

University Medical Center, will be presented with this letter and survey at their initial check-in to the

clinic located at Midwest Orthopaedics at Rush University Medical Center. You can consent to be part

of this study by completing the attached questionnaires. We expect these surveys to take about 15

minutes to fill out. The combined data from these surveys may be published or presnted at scientific meetings.

Surgical Reimbursement Patient Survey

1. What is Your Age? ______years 2. What is your gender?(Check One) Male

Female

3. Have you ever had lumbar(low back) spine surgery? (Check One) Yes

NoIf NO, skip to question 5.

4. Are you satisfied with the outcome of your low back surgery?(Check One) Yes

And what was the procedure? (Discectomy, Laminectomy, Fusion) No

5. Have you ever had cervical (neck) spine surgery? (Check One) Yes

NoIf NO, skip to question 7.

6. Are you happy with the outcome of your neck surgery?(Check One) Yes

And what was the procedure? (Laminectomy, Fusion Front, Fusion back) No

7. What is the highest level of school you completed?(Check One)

Did Not Graduate High School Bachelors or other Undergraduate College Degree

High School or High School Equivalent (GED) Any Graduate Degree

College or University I Prefer Not To Answer

8.What was your approximate household income last year?(Check One)

Less than $20,000 / Year $75,000 - $150,000 / Year Greater than $250,000 / Year

$20,000 - $ 75,000 / Year $150,000 - $250,000 / Year I Prefer Not To Answer

9. What Is Your Primary Health Insurance?(Check One)

Medicare Medicaid HMO Worker’s Compensation

PPO None I Don’t Know

10. What do you think is a reasonable fee that an orthopaedic surgeon should receive to perform a lumbar (low back) discectomy (removing a herniated disc in the low back)?

The surgery involves a 1-2 inch incision to expose the spine. The nerves in your spine are identified and gently moved out of the way. The loose piece of disc that is pushing on the nerves is removed to free up the nerve. The procedure usually involves the use of a microscope and typically takes 1 to 2 hours.Complications include the risk of nerve injury and leakage of spinal fluid. This procedure is typically performed on an outpatient basis.

(The fee includes the operation itself, the time your surgeon spends with you in the hospital, and his or her care for you for 90 days after surgery. The fee DOES NOT include preoperative evaluation or the fee the hospital gets paid.)

Please write the amount here $ ______

11. How much do you estimate that Medicare actually pays for this procedure and aftercare (90 days)?

Please write the amount here $ ______

12. What do you think is a reasonable fee that an orthopaedic surgeon should receive to perform a single level posterior lumbar spine decompression and fusion?

The surgery involves a 4-6 inch incision to expose the spine in the low back. Bone spurs and bulging discs compressing the spinal cordare removed. The spine is fused at that level with screws, rods and bone graft to prevent instability.The procedure typically takes 2-4 hoursand requires a 2-3 day hospitalization.Complications include the risk of nerve injury, leakage of spinal fluid, bleeding and infection.

(The fee includes the operation itself, the time your surgeon spends with you in the hospital,and his or her care for you for 90 days after surgery. The fee DOES NOT include preoperative evaluation or the fee the hospital gets paid.)

Please write the amount here $ ______

13. How much do you estimate that Medicare actually pays for this procedure and aftercare (90 days)?

Please write the amount here $ ______

14. What do you think is a reasonable fee that an orthopaedic surgeon should receive to perform a single level anterior cervical discectomy and fusion?

The surgery involves a 3-4 inch incision to expose the anterior spine in the neck. Dissection must be done very carefully in the neck between the trachea, esophagus and important vessels to expose the cervical spine.Bone spurs and herniated disc compressing the spinal cordare removed. The spine is fused at that level with a plate, screws and bone graft to prevent instability.The procedure typically takes 1-3 hoursand requires an overnight hospitalization.Complications include the risk of nerve injury, leakage of spinal fluid, bleeding, infection and difficulty swallowing.

(The fee includes the operation itself, the time your surgeon spends with you in the hospital,and his or her care for you for 90 days after surgery. The fee DOES NOT include preoperative evaluation or the fee the hospital gets paid.)

Please write the amount here $ ______

15. How much do you estimate that Medicare actually pays for this procedure and aftercare (90 days)?

Please write the amount here $ ______

16. What do you think is a reasonable fee that an orthopaedic surgeon should receive to perform a mutli-level correction and fusion of a scoliotic or curved spine?

The surgery involves a 12-18 inch incision to expose the entire spine in the mid and low back. The curved spine is corrected by placing screws at many levels in the spine with long rods used to straighten the curvature, as well as fusing the spine with bone graft. The procedure takes several hours and many days in the hospital are required for recovery. Complications are more common and include the risk of nerve injury, leakage of spinal fluid, bleeding and infection.

(The fee includes the operation itself, the time your surgeon spends with you in the hospital,and his or her care for you for 90 days after surgery. The fee DOES NOT include preoperative evaluation or the fee the hospital gets paid.)

Please write the amount here $ ______

17. How much do you estimate that Medicare actually pays for this procedure and aftercare (90 days)?

Please write the amount here $ ______

18. Do you think your surgeon should get paid more for doing a minimally invasive procedure? A minimally invasive surgery involves performing similar procedures to those described above using smaller incisions and specialized tubes to access the spine with specialized instruments and implants in order to make recovery from surgery quicker and easier.If so, how much more should the surgeon be paid :

No, they should be paid less 20% more 50-100% more

0%, should be paid the same 20-50% more Greater than 100% more

19. How much do you think a spine surgeon should earn each year? Training consists of 4 years of undergraduate education, 4 years of medical school, at least 5 years of an orthopedic or neurosurgical residency and an additional year of sub-specialty training in spine surgery (Approximately 10 years of post-college training).

Please write the amount here $ ______

20. On average, Medicare pays an orthopaedic surgeon about $971 for performing a lumbar discectomy (removing a herniated disc in the low back, usually a 1 to 2 hour procedure). Please indicate your feeling about this fee (check one)

$971 is much lower than what a surgeon should earn for this procedure.

$971 is somewhat lower than what a surgeon should earn for this procedure.

$971 is about right for what a surgeon should earn for this procedure.

$971 is somewhat higher than what a surgeon should earn for this procedure.

$971 is much higher than what a surgeon should earn for this procedure.

21. On average, Medicare pays an orthopaedic surgeon about $2,413 for performing a single level posterior lumbar spine decompression and fusion (removing bone spurs and bulging discs compressing the spinal cord in the low back, and fusing that level with screws, rods and bone graft to prevent instability, usually a 2-4 hour procedure). Please indicate your feeling about this fee (check one)

$2,413 is much lower than what a surgeon should earn for this procedure.

$2,413 is somewhat lower than what a surgeon should earn for this procedure.

$2,413 is about right for what a surgeon should earn for this procedure.

$2,413is somewhat higher than what a surgeon should earn for this procedure.

$2,413 is much higher than what a surgeon should earn for this procedure.

22. On Average, Medicare pays an orthopaedic surgeon about $2,158 for performing a single level anterior cervical discectomy and fusion(removing bone spurs and herniated disc compressing the spinal cord in the neck, and fusing that level with a plate, screws and bone graft to prevent instability, usually a 2 hr procedure). Please indicate your feeling about this fee (check one)

$2,158 is much lower than what a surgeon should earn for this procedure.

$2,158 is somewhat lower than what a surgeon should earn for this procedure.

$2,158is about right for what a surgeon should earn for this procedure.

$2,158 is somewhat higher than what a surgeon should earn for this procedure.

$2,158 is much higher than what a surgeon should earn for this procedure.

23. Have you read any recent newspaper articles regarding payments for and appropriateness of spinal surgery, and if so have these negatively affected your opinion of spinal surgeons? Yes No

Please feel free to comment on this and offer any additional comments below:

Thank you for your time. Please return the survey in the envelop provided and seal the envelope

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