Trends in Medicare Service Volume for Cataract Surgery and the Impact of the Medicare Physician Fee Schedule

Gong, Dan; Lin, Jie; Tsai, James C.

doi:10.1111/1475-6773.12535

Cited by 12 publications

(7 citation statements)

References 17 publications

(23 reference statements)

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“…According to this model, there is an optimal reimbursement at which DIEP volume would decrease whether the reimbursement rate is raised or lowered. If reimbursement is not set at the optimal level, then the [18][19][20] and substitution 18,[20][21][22] effects for surgical care in scenarios where reimbursements changed while the demand for services remained plausibly constant. Although direct assessments of the elasticity for microsurgical breast reconstruction are lacking, previous research 9 as well as our own results have uncovered disparities in S2068 procedures across insurance types and socioeconomic status, possibly reflecting ongoing substitution away from DIEPs toward alternative methods of breast reconstruction for patients with inferior insurance coverage.…”

Section: Discussionmentioning

confidence: 99%

The Use of Unlisted Billing Codes for Microsurgical Breast Reconstruction and Implications for Code Consolidation

Yang,

Hyland,

Carty

et al. 2024

J Reconstr Microsurg

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Background Private insurers have considered consolidating the billing codes presently available for microvascular breast reconstruction. There is a need to understand how these different codes are currently distributed and used to help inform how coding consolidation may impact patients and providers. Methods Using the Massachusetts All-Payer Claims Database between 2016 and 2020, patients who underwent microsurgical breast reconstruction following mastectomy for cancer-related indications were identified. Multivariable logistic regression was used to test whether an S2068 claim was associated with insurance type and median household income by patient ZIP code. The ratio of S2068 to CPT19364 claims for privately insured patients was calculated for providers practicing in each county. Total payments for professional fees were compared between billing codes. Results There were 272 claims for S2068 and 209 claims for CPT19364. An S2068 claim was associated with age < 45 years (OR: 1.89, 95% CI: 1.11–3.20, p = 0.019), more affluent ZIP codes (OR: 1.11, 95% CI: 1.03–1.19, p = 0.004), and private insurance (OR: 16.13, 95% CI: 7.81–33.33, p < 0.001). Median total payments from private insurers were 101% higher for S2068 than for CPT19364. In all but two counties (Worcester and Hampshire), the S-code was used more frequently than CPT19364 for their privately insured patients. Conclusion Coding practices for microsurgical breast reconstruction lacked uniformity in Massachusetts, and payments differed greatly between S2068 and CPT19364. Patients from more affluent towns were more likely to have S-code claims. Coding consolidation could impact access, as the majority of providers in Massachusetts might need to adapt their practices if the S-code were discontinued.

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Section: Discussionmentioning

confidence: 99%

The Use of Unlisted Billing Codes for Microsurgical Breast Reconstruction and Implications for Code Consolidation

Yang,

Hyland,

Carty

et al. 2024

J Reconstr Microsurg

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“…Other studies have shown similar decreasing Medicare reimbursement rates for various commonly performed ophthalmic and oculoplastic procedures. [20][21][22][23] A study by Gong et al (2017) evaluated the effect of the Medicare PFS on service volume for cataract surgery and found a statistically significant increase in the number of complex cataract surgeries performed between 2005 and 2009, which was also a time when Medicare payments were reduced. 24 Unless the Medicare reimbursement trend remains in the positive direction or at least matches the rate of inflation, there could be many unintended consequences to glaucoma patients and providers.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22][23] A study by Gong et al (2017) evaluated the effect of the Medicare PFS on service volume for cataract surgery and found a statistically significant increase in the number of complex cataract surgeries performed between 2005 and 2009, which was also a time when Medicare payments were reduced. 24 Unless the Medicare reimbursement trend remains in the positive direction or at least matches the rate of inflation, there could be many unintended consequences to glaucoma patients and providers. Ma et al 25 conducted a geospatial analysis of trabeculectomies, glaucoma drainage implants (GDIs), and microinvasive glaucoma surgeries across the United States to generate a form of "GlaucoMap."…”

Section: Discussionmentioning

confidence: 99%

United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000–2020

Francone

Pham

Asahi

et al. 2022

Journal of Glaucoma

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Purpose: The purpose of this study is to investigate US Medicare reimbursement trends for common glaucoma procedures from 2000 to 2020. Materials and Methods: Current Procedural Terminology codes for Glaucoma procedures in the US centers for Medicare and Medicaid Services database were used to conduct this economic analysis. Reimbursement data from the Physician Fee Schedule look-up tool from the Centers for Medicare and Medicaid Services were compiled for the selected procedures and compensation trends were investigated after adjusting for inflation in 2020 US dollars from the unadjusted data between 2000 and 2020. Results: The average adjusted reimbursement for the analyzed procedures decreased by 20.5% [95% confidence interval (CI), −15.4% to −25.6%] over the 20-year period. On average, there was a 1.03% decrease in reimbursement rates per year (95% CI, −0.74% to −1.33%), with an adjusted compound annual growth rate of −1.35% (95% CI, −1.07% to −1.64%). The results show an overall declining rate in reimbursement for the glaucoma procedures analyzed in this study. Conclusions: The US Medicare reimbursement for glaucoma procedures in the United States showed a significant decline between 2000 and 2020. These findings may be relevant to understanding changing practice patterns for glaucoma care.

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“…Furthermore, provider reimbursement from Medicare continues to become more complex and even more challenging to obtain because of the constant changes. Jun, Tsai, and Gong (2016) suggested that the changes in Medicare payments occur in a vacuum and can negatively impact the volume of services and the level of care the hospital provide.…”

Section: The Effects Of Reform On Lowering Reimbursementmentioning

confidence: 99%

Successful Billing Strategies in the Hospital Industry

Merritt-Myrick¹,

Harris²

2020

IJHRS

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This paper explores the negative impact of changing Medicare regulations have on hospital profitability. Findings indicate that the successful strategies billing managers could use to ensure Medicare reimbursement and profitability include remaining up to date with Medicare changing compliance regulations, enhancing communication with staff, multiple departments, and Medicare, and adopting a robust billing system and other systems that compliment billing. Since the implementation of changes, hospitals continued to foster criterion to ensure successful Medicare reimbursement, thereby remaining in operation to continue to support the healthcare needs of families in the local communities. The biggest obstacle for hospitals is the ever-revolving Medicare reform and the effects it has on lowering reimbursement for the hospital industry. Hospitals that are affected by reform report issues that relate to the Medicare Prospective Payment System (PPS), payment for performance, and value-based payments.

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Trends in Medicare Service Volume for Cataract Surgery and the Impact of the Medicare Physician Fee Schedule

Abstract: Reduced Medicare payment was associated with a significant increase in complex cataract service volume but not in noncomplex cataract service volume, resulting in a shift toward performing a greater proportion of complex cataract surgeries from 2005 to 2009.

Cited by 12 publications

References 17 publications

The Use of Unlisted Billing Codes for Microsurgical Breast Reconstruction and Implications for Code Consolidation

The Use of Unlisted Billing Codes for Microsurgical Breast Reconstruction and Implications for Code Consolidation

United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000–2020

Successful Billing Strategies in the Hospital Industry

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