Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members

Abstract

The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states' average reimbursement, reimbursement was not significantly correlated with the state's hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons' peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons.

Management of Unstable Distal Radius Fractures: A Survey of Hand Surgeons

“…Given that around 81% of Hand Fellowship programs are Orthopaedic Surgery programs, 25 this distribution is not unexpected. Mean years in practice after fellowship training were 17.4 years, similar to years of experience among ASSH members in prior studies 26 and the private office setting was the most common type of practice as with prior surveys of ASSH members. 27 However, almost 50% of respondents had some affiliation with academic centers allowing for a broad sampling of different practice types.…”

Atuação do médico cirurgião de mão em microcirurgia no Brasil

“…Our results were different from those found in the literature, in which the active majority of the surgeons had 9 to 20 years of experience. 12 13…”

“…Nossos resultados foram diferentes dos encontrados na literatura, cuja maioria ativa compõe o período entre 9 e 20 anos de atuação. 12 13…”

What Are the Trends in the Utilization of Orthopaedic Advanced Practice Professionals? A Large Database Medicare Study

“…Both physician assistants (PAs) and nurse practitioners (NPs) as advanced practice professionals (APPs) have an increasing role in delivering orthopaedic care. Although estimates predict that the need for orthopaedic care will continue to grow rapidly 1,2 , the work hours of orthopaedic surgeons and residents are likely to decrease because of multiple factors including changes in career planning, retirement trends, lifestyle, and restrictions of resident hours 3,4 . Consequently, to help alleviate this expanding gap, APPs are projected to become more commonplace in orthopaedic practices 5 .…”

“…Under their own National Provider Identifier, both PAs and NPs bill Medicare independently from physicians. Although PAs vastly outnumber NPs in orthopaedics currently 4,7 , the desire of newly graduating APPs to enter orthopaedic clinical practice is high, and the number of postgraduate orthopaedic training programs for APPs is growing 8,9 . Although the responsibilities of APPs depend on the location and the setting of the practice, they commonly include attending rounds, assisting with surgery, managing preoperative and postoperative complications, prescribing treatments, updating medical records, ordering imaging and laboratory studies, and performing administrative functions 10,11 .…”