An Analysis of Medicare Reimbursement Rates in Hysterectomies Performed in Gynecologic Surgery: 2010-2019

Abstract

Study Objective To investigate differences in Medicare reimbursement rates between type of hysterectomy procedure, including abdominal, vaginal, and laparoscopic/robotic to help guide reimbursement for best practices. Design Twenty-two reimbursement codes representing hysterectomy from The Physician Fee Schedule Look-Up Tool. Setting Centers for Medicare & Medicaid Services. Patients or Participants All patients who had undergone hysterectomy of any type with reimbursement by Medicare using the twenty-two codes represented in The Physician Fee Schedule Look-Up Tool from 2010-2019 in the United States. Interventions Abdominal, vaginal, or laparoscopic/robotic hysterectomy reimbursed by Medicare. Measurements and Main Results A total of twenty-two codes were identified and the average annual and total percent change in reimbursement were calculated for abdominal, vaginal, and laparoscopic/robotic hysterectomy. After adjusting for inflation, the average reimbursement for all hysterectomy procedures decreased by 14.97% from 2010 to 2019 with an average R2 of 0.92. The average annual change in reimbursements was 1.75%. Reimbursement for abdominal, vaginal, and laparoscopic/robotic hysterectomies decreased by 7.85%, 10.17%, and 21.16%, with an average R2 of 0.94, 0.96, 0.88, respectively. Annual decrease in reimbursements was 0.90%, 1.18%, 1.56% for abdominal, vaginal, and laparoscopic/robotic respectively. These numbers show a decrease in reimbursement for all hysterectomies, and by hysterectomy type. Conclusion Medicare reimbursement for hysterectomy declined significantly from 2010-2019. Laparoscopic/robotic hysterectomy reimbursement decreased more than other modalities. With increasing use of laparoscopic/robotic procedures for hysterectomies in gynecologic surgeries due to increased safety, it is critical to understand these reimbursement trends. A minimally invasive approach should be the standard of care for benign hysterectomy, as it has improved patient outcomes and safety. Reimbursement does not reflect this best medical practice as minimally invasive hysterectomy rates decreased more than laparotomy. Further understanding of trends is essential to provide input to policy-makers who determine these reimbursement rates.