An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019

Thornburg, Danielle A.; Gupta, Nikita; Chow, Nathan; Haglin, Jack M.; Noland, Shelley S.

doi:10.1177/1558944721990807

Cited by 15 publications

(13 citation statements)

References 23 publications

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“…Similar trends have been reported across other surgical specialties and procedures. [3][4][5][6][24][25][26][27][28][29] In addition, Harrington et al 30 found a 7.1% increase in total office visits to neurosurgeons from 2011 to 2018 but an 8.3% inflation-adjusted decrease in the average Medicare reimbursement. Neurosurgeons were billing for more time but were reimbursed a smaller percentage of submitted charges.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

et al. 2023

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BACKGROUND:An estimated 50 million Americans receive Medicare health care coverage. Prior studies have established a downward trend in Medicare reimbursement for commonly billed surgical procedures, but it is unclear whether these trends hold true across all neurosurgical procedures.OBJECTIVE:To assess trends in utilization, charges, and reimbursement by Medicare for neurosurgical procedures after passage of the Affordable Care Act in 2010.METHODS:We review yearly Physician/Supplier Procedure Summary datasets from the Centers for Medicare and Medicaid Services for all procedures billed by neurosurgeons to Medicare Part B between 2011 and 2019. Procedural coding was categorized into cranial, spine, vascular, peripheral nerve, and radiosurgery cases. Weighted averages for charges and reimbursements adjusted for inflation were calculated. The ratio of the weighted mean reimbursement to weighted mean charge was calculated as the reimbursement-to-charge ratio, representing the proportion of charges reimbursed by Medicare.RESULTS:Overall enrollment-adjusted utilization decreased by 12.1%. Utilization decreased by 24.0% in the inpatient setting but increased by 639% at ambulatory surgery centers and 80.2% in the outpatient setting. Inflation-adjusted, weighted mean charges decreased by 4.0% while reimbursement decreased by 4.6%. Procedure groups that saw increases in reimbursement included cervical spine surgery, cranial functional and epilepsy procedures, cranial pain procedures, and endovascular procedures. Ambulatory surgery centers saw the greatest increase in charges and reimbursements.CONCLUSION:Although overall reimbursement declined across the study period, substantial differences emerged across procedural categories. We further find a notable shift in utilization and reimbursement for neurosurgical procedures done in non-inpatient care settings.

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Section: Discussionmentioning

confidence: 99%

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

et al. 2023

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“…Orthopaedic sports medicine has experienced a similar decrease in reimbursement to other fields of orthopaedic surgery, with the mean inflation-adjusted Medicare reimbursement decreasing 39% for hip and knee arthroplasty, 17 27% for shoulder and elbow surgeries, 28 22.6% for hand surgeries, 40 30% for commonly performed arthroscopy procedures, 29 and 30% for orthopaedic trauma. 19 Accordingly, this study corroborates the findings of decreasing reimbursement found in other subspecialties of orthopaedic surgery and further defines the reimbursement decrease in orthopaedic sports medicine (Appendix Table A2 ).…”

Section: Discussionmentioning

confidence: 99%

“…13,18,20,21,32,33 Furthermore, many orthopaedic surgery subspecialties including total joint replacement, trauma, hand and wrist, and shoulder have reported decreases. 17,19,28,36,40 While these subspecialties have been well defined, there is a paucity of literature regarding Medicare reimbursement in orthopaedic sports medicine. One such applicable study by Moore et al 29 examined arthroscopic procedures and reported a 30% decrease in reimbursement for the included 20 procedures.…”

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confidence: 99%

Inflation-Adjusted Medicare Reimbursement Has Decreased for Orthopaedic Sports Medicine Procedures: Analysis From 2000 to 2020

Pollock

Richman

Estipona

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Decreases in Medicare reimbursement have been noted among many medical specialties. An in-depth analysis of the subspecialty of orthopaedic sports medicine is needed to determine changes in Medicare reimbursement in this field. Purpose/Hypothesis: The purpose was to elucidate the trends in inflation-adjusted Medicare reimbursement for orthopaedic sports medicine procedures between 2000 and 2020. It was hypothesized that Medicare reimbursement decreased substantially during the study period. Study Design: Economic decision and analysis; Level of evidence, 4. Methods: The Physician Fee Schedule Look-up Tool was used to extract Medicare reimbursement information between 2000 and 2020 for 67 procedures related to orthopaedic sports medicine. These values were adjusted for inflation using the Consumer Price Index. The compound annual growth rate (CAGR) was calculated to measure the annual rate of change, and descriptive analyses were performed using the Student t test. Results: Between 2000 and 2020, inflation-adjusted Medicare reimbursement for the 67 included procedures decreased by an average of 33% (CAGR = –2.2%; R 2 = 0.78). Reimbursement decreased for procedures related to the shoulder and elbow by 34% (CAGR = –2.3%; R 2 = 0.80), for hip-related procedures by 23% (CAGR = –1.4%; R 2 = 0.77), for knee-related procedures by 31% (CAGR = –2.0%; R 2 = 0.81), and for procedures relating to the foot and ankle by 38% (CAGR = –2.5%; R 2 = 0.79). Conclusion: Study findings indicated that inflation-adjusted Medicare reimbursement decreased substantially between 2000 and 2020 for orthopaedic sports medicine procedures, ranging from a 23% decrease for hip-related procedures to a 38% decrease for foot and ankle–related procedures. The results of this study could be used to provide further context for health care policy decisions and help ensure sustainable financial environments for orthopaedic sports medicine surgeon.

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“…The data reported in this study are inconsistent with several previous evaluations of monetary trends in plastic surgery. 11,[17][18][19] The current landscape of literature suggests that adjusted Medicare reimbursement is downtrending for various reconstructive procedures, with changes not keeping pace with the rate of inflation. These prior studies coincide with general findings that Medicare payment rates are lagging far behind general inflation and physician practice expenses.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Analysis of the Common Injections Performed by Plastic Surgeons: 2012 and 2019

Harrington

Kandi

Janbieh

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Plastic surgeons regularly perform injections for both cosmetic and functional purposes. This article examines the most common injections utilized by plastic surgeons under Medicare and how their usage and billing has changed between 2012 and 2019. Methods: Using the earliest and latest data available on the Centers for Medicare and Medicaid Services’ Provider Utilization and Payment Data File, we first determined Healthcare Common Procedure Coding System injection codes most billed to Medicare in 2012 and 2019. The number of services, amount of Medicare beneficiaries, and reimbursement rates were collected and analyzed for each Healthcare Common Procedure Coding System code from the Provider Utilization and Payment Data File for years 2012 and 2019. We compared the change in reimbursement rate for each injection to the rate of inflation in US dollars over the same period. Results: The unadjusted Medicare reimbursement rate for eight included injection types increased an average of 31.63% during the study period. This was not significantly different from the rate of inflation during the same period (+11.33%, P = 0.311). When all Medicare reimbursement data were adjusted for inflation to 2019 dollars, the average percentage change in reimbursement for all included injections in this study increased by 17.58% from 2012 to 2019. Conclusions: The findings from our study suggest that injections administered by plastic surgeons appear to be unique in their general stability in reimbursement rates as compared to rates in other fields. Further research should be performed to better understand the driving factors for usage and reimbursement changes.

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An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019

Cited by 15 publications

References 23 publications

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

Inflation-Adjusted Medicare Reimbursement Has Decreased for Orthopaedic Sports Medicine Procedures: Analysis From 2000 to 2020

A Comparative Analysis of the Common Injections Performed by Plastic Surgeons: 2012 and 2019

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