Trends of Medicare Reimbursement Rates for Microsurgery Procedures

Abstract

Volume 149, Number 4 • Viewpoints 837e Medicaid Services, relative value units dictate the exact dollar amount reimbursed to providers for any given medical service or procedure. We sought to identify and describe trends in Medicare reimbursement for microsurgery procedures from 2007 to 2020 in comparison to inflation. This study conformed to the Declaration of Helsinki's ethical principles for medical research.We identified Current Procedural Terminology (CPT) codes pertaining to procedures that utilize commonly performed microsurgical techniques (Table 1). Using the Physician Fee Schedule Look-Up Tool, available through the Centers for Medicare and Medicaid Services, we gathered relevant data around the relative value units for work, practice expense, and professional liability insurance as well as the conversion factors for each microsurgical CPT code from 2007 to 2020. Inflation data, as well as the general consumer price index, were obtained through the U.S. Department of Labor; these data are freely accessible through the Bureau of Labor Statistics. We utilized descriptive statistics as described in our previous publication. 2 We found that Medicare reimbursement for the 34 included codes increased, on average, by 2.28 percent from 2007 to 2020. The range of unadjusted difference in reimbursement was wide (−22 percent to +24 percent). The consumer price index changed by 27 percent from 2007 to 2020, according to the U.S. Department of Labor. After adjusting for changes in inflation rate, we found that Medicare reimbursement decreased by 1.74 percent annually, on average. Relative differences in overall reimbursement decreased for the included CPT codes from 2007 to 2020 by 19.97 percent, on average, when we adjusted for inflation (Table 2). In the included years, physician work, practice expense, and professional liability insurance relative value units increased (work, 0.59 percent; facility, 11.00 percent; malpractice, 96.13 percent). The change in conversion factor was −4.78 percent across the study period.Our results demonstrate that Medicare reimbursement rates for microsurgery are lagging behind consumer price index inflation. A recent study showed that microsurgical procedures are profitable for hospitals while reimbursement rates remain low for physicians by looking at projected Medicare payments to the surgeon and hospital for head and neck reconstructive microsurgery procedures 3 ; similar trends for low reimbursement for breast reconstruction have also been demonstrated. 4 The effects of inflation on Medicare reimbursement may also particularly affect microsurgical procedures, which have an added layer of complexity due to coding rules and bundling of the reimbursements for both the procedure and the use of the operating microscope. It is crucial for these data to be readily available to physicians given that Medicare may now include certain patients under age 65. Microsurgical procedures are performed on patients of all ages, so understanding these trends is particularly important in this con...

Billing and Utilization Trends in Reconstructive Microsurgery Indicate Worsening Access to Care

“…[4][5][6] This is true for the field of microsurgery as a whole but also for specific procedures within microsurgery, such as lower extremity operations. 7 Microsurgery may be particularly affected by these rising costs due to its use of advanced technology, such as microscopes and specialized imaging.…”

Key stakeholders' perspectives: A gap analysis of hospital‐acquired pressure injuries

“…Li et al's meta-analysis found that 1 in 10 patients hospitalized will acquire a pressure injury (PI), with European and North American regions having the highest hospital incidence rates (14.4%, 8.3%, respectively). Related to specific countries, the Siotos et al (2022) global burden of disease study reported that the United States had an incidence rate higher than the average high socio-demographic indexed country. The economic impact of hospital-acquired pressure injuries (HAPI) occurrences in the United States alone is more than $26.8 billion annually and includes negative patient outcomes of increased lengths of stay, serious infection, severe pain, and death (Padula & Delarmente, 2019).…”

Discussion: Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties

“…Variation in reimbursement per RVU may be explained by the fact that it is challenging to accurately quantify physician work, leading to some codes reflecting the amount of physician work involved more accurately than others. 7,8 In general, inadequate reimbursement for microsurgical procedures may impact patient access through surgeons’ choice of subspecialty, practice setting, and case selection. For instance, between 2003 and 2013, the average Medicare reimbursement for microsurgical autologous breast reconstruction was 22.9% of total charges.…”