MP17-17 CHANGES IN SURGEON FEES FOR URINARY CATHETERIZATION OVER THE HISTORY OF THE UNITED STATES

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-17 CHANGES IN SURGEON FEES FOR URINARY CATHETERIZATION OVER THE HISTORY OF THE UNITED STATES Vincent Wong, Sean Fullerton, and John Phillips Vincent WongVincent Wong More articles by this author , Sean FullertonSean Fullerton More articles by this author , and John PhillipsJohn Phillips More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: From 1992-2021, CMS has calculated surgical fees based on a procedure’s relative value units (RVUs). Earlier methods (1966-1991) of reimbursement were based on ‘usual, customary, and reasonable fees’ charged by doctors. Surgical billing and charges before 1965 are largely unknown and have not been previously reported. Urinary catheterization as a transurethral means to drain the bladder, was reasonably similar in technique in the early 1800s to what is observed today. Our objective is to use surgical billing for urinary catheterization to gauge changes in surgeon reimbursement over the history of the United States. METHODS: We obtained historical billing records from state and regional medical societies, archives, and reports from the digital archives of Hathitrust (Ann Arbor), the National Library of Congress (Washington), and the Directories of Prevailing Charges from the Center for Medicare Services (CMS). We obtained RVUs and conversion factors from CMS to calculate charges for 1992-2020. We obtained calculated consumer price indices (CPI) from Oregon State University. We considered non-parametric statistical methods to assess for changes in CPI–corrected dollars with an alpha at 0.05 RESULTS: We found 27 published fee tables of surgical procedures from 1818-1920 that provided the pricing for a first encounter, male urinary catheterization and found surgical fees for this procedure, using 2020-adjusted dollars, remained flat throughout the 19th century study period with an average price of $113.04+/-38.06 from 1818-1950 compared to $131.20+/-169.53 from 1851-1900 (p=0.67) reflecting the deflationary 19th century. In comparison, during the pre-RVU based Medicare years of 1976 to 1984, the average reimbursement for urinary catheterization was $73.87+/-2.38. In the RVU-era, from 1992 to 2020, the average reimbursement for urinary catheterization was $23.05+/-4.69. Reimbursement from 1992 to 2000 has increased by $3.00, or $8.00 less than what would be predicted by inflation alone. CONCLUSIONS: Surgical reimbursement for urinary catheterization decreased by 79.6% over the 200 year study period despite increases in technological safety, training required, and liability. Modern surgical reimbursement 1992-2000 trails increases in inflation and may mirror trends in other urologic procedures. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e314-e315 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vincent Wong More articles by this author Sean Fullerton More articles by this author John Phillips More articles by this author Expand All Advertisement Loading ...