Abstract

You have accessJournal of UrologyCME1 Apr 2023MP39-08 CHANGES IN MEDICARE REIMBURSEMENT FOR TOP UROLOGY PROCEDURES BY STATE 2011-2022 Nathaniel Kimball, Alexander Dorius, Carson Bateman, and Pranav Sharma Nathaniel KimballNathaniel Kimball More articles by this author , Alexander DoriusAlexander Dorius More articles by this author , Carson BatemanCarson Bateman More articles by this author , and Pranav SharmaPranav Sharma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medicare enrollment has increased steadily since 2006, increasing the demand for urological procedures for Medicare beneficiaries. Previous studies on Medicare reimbursement have lacked state-by-state analysis. In this study, we analyzed reimbursement rates for the 100 most common urology procedures from 2011 to 2022, identifying which states and territories showed the greatest change. METHODS: The Center for Medicare and Medicaid Services’ Physician Fee Schedule database was analyzed to find the 100 most common urology Current Procedural Terminology codes. Medicare Administrative Contractor localities were used to identify varying facility-based reimbursement for each state or territory. Yearly reimbursement was adjusted for inflation by utilizing the consumer price index. The representation for each procedure was weighted according to frequency. Lastly, a percent change in reimbursement was generated for each U.S. state or territory. RESULTS: Over the twelve-year period, the inflation-adjusted Medicare reimbursement for the top urological procedures for all U.S. states and territories decreased annually by an average of 3.81%. Puerto Rico (-2.80%), New York (-3.33%), Washington (-3.51%), Maryland (-3.57%), and Louisiana (-3.58%) showed the smallest yearly precent change. Illinois (-4.27%), Idaho (-4.09%), Mississippi (-4.07%), Kansas (-4.06%), and Indiana (-4.05%) showed the greatest annual decrease in reimbursement. Total decrease in reimbursement from 2011-2022 ranged from -33.6% to -51.24%. The Figure 1 below showcases the average yearly percent change by state or territory. CONCLUSIONS: Medicare reimbursement for urological procedures decreased from 2011-2022. Our study suggests that specific areas have more or less favorable reimbursement rates than others. Because of the increasing number of adults covered by Medicare, urologists face mounting pressure to advocate for greater reimbursement for the procedures they perform. There remains incentive for physicians to practice in states with higher Medicare reimbursement versus more unfavorable areas. Continued advocacy should be taken to resolve diminishing reimbursement for urology procedures so quality of care is not impacted for Medicare beneficiaries. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e537 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathaniel Kimball More articles by this author Alexander Dorius More articles by this author Carson Bateman More articles by this author Pranav Sharma More articles by this author Expand All Advertisement PDF downloadLoading ...

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