A Comparison of Hysterectomy and Prostatectomy Medicare Reimbursement Rates: 2010-2019

Abstract

Study Objective To investigate differences in Medicare reimbursement rates between hysterectomy and prostatectomy to understand gender disparities in healthcare reimbursement. Design Ten codes representing hysterectomy and five codes representing prostatectomy from The Physician Fee Schedule Look-Up Tool. Setting Centers for Medicare & Medicaid Services. Patients or Participants All patients who had undergone hysterectomy or prostatectomy with reimbursement by Medicare using the fifteen codes represented in The Physician Fee Schedule Look-Up Tool from 2010-2019 in the United States. Interventions Hysterectomy or prostatectomy reimbursed by Medicare. Measurements and Main Results The codes were identified and the average annual and total percent change in reimbursement were calculated from 2010 to 2019. After adjusting for inflation, the average reimbursement for abdominal hysterectomy procedures decreased by 7.85% and for laparoscopic hysterectomy procedures by 21.16% with average R2 values of 0.94 and 0.88, respectively. The average reimbursement for open prostatectomy procedures decreased by 23.61% and by 28.20% for laparoscopic prostatectomy procedures with average R2 values of 0.86 for both. The average reimbursement rate in dollar amount for abdominal hysterectomy is $1068.68 and $1,374.25 for open prostatectomy. The average reimbursement rate in dollar amount for laparoscopic hysterectomies and prostatectomies are $1,053.32 and $1,775.65, respectively. Conclusion This study provides an analysis of trends in procedural Medicare reimbursement for hysterectomy procedures and prostatectomy procedures. Medicare reimbursement rates for hysterectomies have decreased by a smaller amount than prostatectomy procedures, although average reimbursement for hysterectomy procedures still remains lower. Reimbursement for procedures are calculated based on multiple factors, but gender equity should be an important factor for policy makers. Results from this study show that while male-specific procedures are still reimbursed more, there is a more rapid decline in reimbursement rates for male-specific procedures, potentially signaling movement towards greater equality. Further work must be done to understand why inequalities still exist in the medical field regarding reimbursement for sex-specific procedures.