Changes In Medicare Reimbursement Research Articles

Physician responses to Medicare reimbursement rates

This paper investigates how office-based physicians respond to Medicare reimbursement changes. Using variation from an Affordable Care Act policy that increased reimbursements for office-based care in four states, we use a triple difference analysis, comparing physicians with higher and lower reimbursement changes in treated states to similar physicians in untreated states. We find two mechanisms through which physicians respond. First, the reimbursement change affected integration—physicians with larger increases in office-based reimbursement were less likely to vertically integrate with hospitals and more likely to continue providing office-based care than physicians with smaller reimbursement increases. Second, we find some evidence that physicians who continued practicing in an office setting increased the volume of services provided.

Comparing Changes in Medicare Reimbursement for Radiation Oncology and Medical Oncology (2010-2020)

A recent study found that radiation oncology (RO) has seen significant declines in Medicare reimbursement (MCR) from 2010-2019. While it is presumed that other cancer subspecialties have seen decreasing MCR, to our knowledge, there are no studies directly comparing changes in MCR between RO and other oncology subspecialties. In this study, we analyze changes in MCR from 2010-2020 for both RO and medical oncology. We hypothesized that the declines in MCR will be similar between the two fields. The publicly available Physician/Supplier Procedure Summary (PSPS) database was used for all years from 2010-2020. All reimbursement for providers with primary provider codes 92 (RO) and 83 and 90 (heme/onc and medical oncology, respectively) were analyzed. For the 150 most highly-reimbursed HCPCS codes for each specialty in 2010, the total allowed charge for each code was corrected for inflation and then divided by the number of submitted claims to calculate average MCR per code for each year. For each code and each specialty, the 2020 billing frequency was multiplied by the calculated average reimbursement per claim in a given year to calculate what the reimbursement would have been in that year using 2020 dollars and utilization rates (projected reimbursement). The projected reimbursement was summed for all HCPCS codes in each year for each specialty to calculate an aggregate MCR for that specialty for that year. This aggregate MCR was then compared with the actual 2020 reimbursement for that basket of codes to calculate the change in MCR over time. Both medical and radiation oncology saw decreases in projected vs. actual MCR from 2010-2020 for this basket of services (Table). Adjusting for inflation and utilization, RO MCR declined by $0.7 billion (B) (-29.0%) from 2010 to 2020 and by $0.2B (-10.5%) from 2015 to 2020 while medical oncology MCR declined by $0.8B (-14.7%) from 2010-2020 and by $0.4B (-6.6%) from 2015-2020. The average decrease per year in projected vs. actual reimbursement for RO was 2.9% (2010 to 2015) and 1.05% (2015 to 2020) and for medical oncology was 1.5% (2010-2015) and 0.7% (2015-2020), respectively. Adjusting for inflation, Medicare reimbursement for a large array of services has declined for both medical oncology and RO from 2010 - 2020. Contrary to our hypothesis, RO reported a 97% greater relative decline in reimbursement compared with medical oncology from 2010 - 2020. Significant decreases in reimbursement to both fields and their potential implications on patient care and access to care should be considered by policymakers while shifting towards an episode-based Alternative Payment Model and when considering further cuts to Medicare reimbursement.

Benchmarking the Radiation Oncology Alternative Payment Model: Changes in Medicare Reimbursement for 16 Common Radiation Therapy Treatment Courses

Radiation oncology (RO) has seen declines in Medicare reimbursement (MCR) in the past decade under the current fee-for-service model. Although studies have explored decline in reimbursement at a per-code level, to our knowledge there are no recent studies analyzing changes in MCR over time for common RO treatment courses. By analyzing changes in MCR for common treatment courses, our study had 3 objectives: (1) to provide practitioners and policymakers with estimates of recent reimbursement changes for common treatment courses; (2) to provide an estimate of how reimbursement will change in the future under the current fee-for-service model if current trends continue; and (3) to provide a baseline for treatment episodes in the event that the episode-based Radiation Oncology Alternative Payment Model is eventually implemented. Specifically, we quantified inflation- and utilization-adjusted changes in reimbursement for 16 common radiation therapy (RT) treatment courses from 2010 to 2020. Centers for Medicare & Medicaid Services Physician/Supplier Procedure Summary databases were used to obtain reimbursement for all RO procedures in 2010, 2015, and 2020 for free-standing facilities. Inflation-adjusted average reimbursement (AR) per billing instance was calculated for each Healthcare Common Procedure Coding System code using 2020 dollars. For each year, the billing frequency of each code was multiplied by the AR per code. Results were summed per RT course per year, and AR for RT courses were compared. Sixteen common RO courses for head and neck, breast, prostate, lung, and palliative RT were analyzed. AR decreased for all 16 courses from 2010 to 2020. From 2015 to 2020, the only course that increased in AR was palliative 2-dimensional 10-fraction 30 Gy, which increased by 0.4%. Courses using intensity modulated RT saw the largest AR decline from 2010 to 2020, ranging from 38% to 39%. We report significant declines in reimbursement from 2010 to 2020 for common RO courses, with the largest declines for intensity modulated RT. Policymakers should consider the significant cuts to reimbursement that have already occurred when considering future reimbursement adjustment under the current fee-for-service model or when considering mandatory adoption of a new payment system with further cuts and the negative effect of such cuts on quality and access to care.

MP39-08 CHANGES IN MEDICARE REIMBURSEMENT FOR TOP UROLOGY PROCEDURES BY STATE 2011-2022

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 ...

Changes in Billing and Reimbursement for Urology Office Visits Before and After Medicare Payment Reforms.

The impact of Medicare reimbursement changes on urology office visit reimbursements has not been fully examined. This study aims to analyze the impact of urology office visit Medicare reimbursements from 2010 to 2021, with a focus on 2021 Medicare payment reforms. The Centers for Medicare and Medicaid Services Physician/Procedure Summary data from 2010-2021 were utilized to examine office visit CPT (Current Procedural Terminology) new patient visit codes 99201-99205 and established patient visit codes 99211-99215 by urologists. Mean office visit reimbursements (2021 USD), CPT specific reimbursements, and proportion of level of service were compared. The 2021 mean visit reimbursement was $110.95, up from $99.42 in 2020 and $94.44 in 2010 (both P < .001). From 2010 to 2020, all CPT codes, except for 99211, had a decrease in mean reimbursement. From 2020 to 2021, there was an increase in mean reimbursement for CPT codes 99205, 99212-99215 and decreases in 99202, 99204 and 99211 (P < .001). New and established patient urology office visits had significant migration of billing codes from 2010 to 2021 (P < .001). New patient visits were most commonly as 99204, which increased from 47% in 2010 to 65% in 2021 (P < .001). The most commonly billed established patient urology visit was 99213 until 2021 when 99214 became the most common at 46% (P < .001). Urologists have seen increases in mean reimbursements for office visits both before and after the 2021 Medicare payment reform. Contributing factors consist of increased established patient visit reimbursements despite decreased new patient visit reimbursements, and changes in level of CPT code billings.

Disparities in erythropoiesis-stimulating agent use after changes in medicare reimbursement and implementation of a risk evaluation and mitigation strategy

Disparities in erythropoiesis-stimulating agent use after changes in medicare reimbursement and implementation of a risk evaluation and mitigation strategy

Changes Over Time for Radiation Oncology Reimbursement for Specific Treatment Courses

<h3>Purpose/Objective(s)</h3> Radiation oncology (RO) has seen declines in Medicare reimbursement (MCR) and will see an additional $300 million projected decline if the RO Alternative Payment Model (RO-APM) is implemented. To our knowledge there are no contemporary studies analyzing changes in MCR over time for common RO treatment courses. Understanding how reimbursement for RO courses has changed over time will provide a baseline comparison for the RO-APM, as MCR under RO-APM is episode-based. Our study aims to quantify changes in MCR for common photon RT treatment courses from 2010 to 2020. We hypothesize that the declines will be highest for IMRT treatment courses. <h3>Materials/Methods</h3> CMS Physician/Supplier Procedure Summary databases were used to obtain reimbursement for all RO procedures in 2010, 2015, and 2020 for free-standing facilities. Average reimbursement (AR) per billing instance was calculated for each Healthcare Common Procedure Coding System code using 2020-adjusted dollars. For each RT course, a RO billing expert selected the codes associated with that course along with the billing frequency of each code. For each year, the billing frequency of each code for a given treatment was multiplied by the AR per code and the results summed. AR for 15 common RO courses were analyzed: head and neck (HN), breast (B), prostate (P), lung (L), and palliative (Pa)(Table). <h3>Results</h3> AR decreased for all 15 courses from 2010 to 2020. From 2015 to 2020, the only course that increased in AR was palliative 2D 30 Gy/10 (0.4% increase). IMRT courses saw the largest AR decline from 2010 to 2020. The AR for a 37-fx prostate bed IMRT plan averaged $32.1K in 2010, $23K in 2015 (-28%), and $19.7K in 2020 (-39%). The AR for a 5-fx IMRT accelerated partial breast irradiation (APBI) averaged $6.9K in 2010, $5.2K in 2015 (-25%) and $4.2K in 2020 (-39%). <h3>Conclusion</h3> We report significant declines in MCR from 2010 – 2020 for common RO courses with the largest declines for IMRT. Hypofractionated regimens were not spared severe cuts, discouraging its broader adoption. Policymakers should consider the significant cuts to MCR that have already occurred when considering further cuts, and the negative impact of such cuts on quality and access to care.

Trends in Reimbursement for Index Surgical Oncology Procedures in Contemporary Practice: Declining Reimbursement for Surgical Oncology Procedures-How Low Do We Go?

BackgroundComprehensive trends in Medicare reimbursement, increasingly relevant to current and future surgical oncology practice, have not been well studied.ObjectiveThe aim of this study was to analyze Medicare reimbursement for index surgical oncology procedures between 2007 and 2021.MethodsUsing the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services, reimbursement data from 2007 to 2021 were obtained for 23 index surgical oncology procedures. Total change in Medicare reimbursement, yearly rates of change, and compound annual growth rate were then calculated. All data were corrected for inflation using the consumer price index. Subset analysis was performed to assess the most recent 5-year trends.ResultsOverall reimbursement for the index surgical oncology procedures increased by an average of 21.6% from 2007 to 2021. After correcting for inflation, average reimbursement decreased to − 8.6%, with the greatest decline seen for thyroid surgery (− 16.9%). Breast surgery was the only category to experience an increase in adjusted reimbursement (9.0%). The average compound annual growth rate for all procedures was − 0.68% from 2007 to 2021. In the most recent 5-year subanalysis, the yearly decrease in inflation-adjusted Medicare reimbursement averaged − 2.47% per year, in comparison with the − 0.60% overall rate of yearly decline (p < 0.005).ConclusionAdjusted Medicare reimbursement for surgical oncology procedures decreased steadily from 2007 to 2021, with an accelerating trend over the last 5 years. As the Medicare population increases, surgical oncologists need to understand these trends so they may consider practice implications, advocate for proper reimbursement models, and preserve access to surgical oncology services.

Buyer beware: analysis of changes to the 2021 Center for Medicare and Medicaid Services physician fee schedule for shoulder surgeons Medicare physician fee schedule changes

BackgroundBecause of budget neutrality rules in the United States Congress, the rates for reimbursable medical expenses with Medicare have been on a recent and consistent decline. The Center for Medicare and Medicaid Services (CMS) continued to proceed with cuts to the 2021 physician fee schedule. There has been an overall 3.3% decrease in the valuation of work relative value units per CMS guidelines. Conversely, CMS has increased the value of certain in office evaluation and management (E/M) services and changed the criteria for level of visit based on complexity of decision-making. The direct effects of these changes to shoulder and elbow surgeons are unknown. This study evaluates the effect of these changes in Medicare reimbursement from 2020 to 2021 among a group of high-volume shoulder and elbow surgeons. MethodsBilling data were queried for 9 fellowship-trained shoulder & elbow surgeons at a high-volume surgical practice from 2020 to 2021. Office-based E/M and surgical codes for shoulder arthroplasty and other common shoulder and elbow codes were used. We compared volume data and change to reimbursement using the 2020 and 2021 Medicare physician fee schedule. The impact of increased E/M billing levels using the new 2021 CMS criteria was also calculated and compared between years. ResultsComparing 2020 to 2021, there was a 18.7% decrease in level 3 visits (17,208 vs. 13,990) and a corresponding 371% increase in level 4 visits billed (1138 vs. 5362). Evaluating the overall impact of this shift on reimbursement from office-based E/M codes, there was a significant increase with an average of $57,954 per surgeon (range = $20,394-$118,916) for this group of 9 surgeons. However, surgical reimbursement for most commonly performed arthroscopic and open shoulder and elbow procedures decreased for 5 of 9 surgeons, with an average decrease of $13,015 (range = −$80,980 to $44,246). When arthroplasty reimbursements were combined with those for other common procedures, there was a decreased surgical reimbursement, totaling $117,135 for all surgeons combined. ConclusionIn this practice of 9 high-volume shoulder and elbow surgeons, a significant decrease in CMS reimbursement related to surgical procedural reimbursement from 2020 to 2021 was experienced. However, increasing the rates of E/M reimbursement and the augmented visit level rules helped offset and exceed the lost revenue from surgical procedures. Caution must be taken: this one time increase in office-based billing coupled with continued annual cuts to surgical procedure valuation is not a sustainable model moving forward. Level of EvidenceLevel IV; Retrospective Case Series; Economic Model.

Inflation-Adjusted Medicare Reimbursement Has Decreased for Orthopaedic Sports Medicine Procedures: Analysis From 2000 to 2020.

Background:Decreases in Medicare reimbursement have been noted among many medical specialties. An in-depth analysis of the subspecialty of orthopaedic sports medicine is needed to determine changes in Medicare reimbursement in this field.Purpose/Hypothesis:The purpose was to elucidate the trends in inflation-adjusted Medicare reimbursement for orthopaedic sports medicine procedures between 2000 and 2020. It was hypothesized that Medicare reimbursement decreased substantially during the study period.Study Design:Economic decision and analysis; Level of evidence, 4.Methods:The Physician Fee Schedule Look-up Tool was used to extract Medicare reimbursement information between 2000 and 2020 for 67 procedures related to orthopaedic sports medicine. These values were adjusted for inflation using the Consumer Price Index. The compound annual growth rate (CAGR) was calculated to measure the annual rate of change, and descriptive analyses were performed using the Student t test.Results:Between 2000 and 2020, inflation-adjusted Medicare reimbursement for the 67 included procedures decreased by an average of 33% (CAGR = –2.2%; R 2 = 0.78). Reimbursement decreased for procedures related to the shoulder and elbow by 34% (CAGR = –2.3%; R 2 = 0.80), for hip-related procedures by 23% (CAGR = –1.4%; R 2 = 0.77), for knee-related procedures by 31% (CAGR = –2.0%; R 2 = 0.81), and for procedures relating to the foot and ankle by 38% (CAGR = –2.5%; R 2 = 0.79).Conclusion:Study findings indicated that inflation-adjusted Medicare reimbursement decreased substantially between 2000 and 2020 for orthopaedic sports medicine procedures, ranging from a 23% decrease for hip-related procedures to a 38% decrease for foot and ankle–related procedures. The results of this study could be used to provide further context for health care policy decisions and help ensure sustainable financial environments for orthopaedic sports medicine surgeon.

Decreases in Radiation Oncology Medicare Reimbursement Over Time: Analysis by Billing Code

Decreases in Radiation Oncology Medicare Reimbursement Over Time: Analysis by Billing Code

Trends of Medicare Reimbursement Rates for Common Plastic Surgery Procedures.

Knowledge of Medicare reimbursement is essential for plastic surgeons providing care to Medicare beneficiaries. The authors sought to evaluate changes in Medicare reimbursement for common plastic surgery procedures from 2010 to 2020. The authors assessed the Physician Fee Schedule of the Centers for Medicare and Medicaid Services website. Rates of work-, facility-, or malpractice-related relative value units and total monetary units for 26 common plastic surgery procedures between 2010 and 2020 were evaluated. Descriptive statistics were used to calculate relative differences and to compare observed changes over time with the rate of inflation. For the selected procedures, the authors found an average relative difference in terms of monetary units of an increase by 2.02 percent. However, after adjusting for inflation, the average relative difference was a decrease by 14.31 percent. The authors' analysis indicates that, on average, there was a 1.55 percent decrease in physician relative value units between 2010 and 2020. Medicare reimbursement rates have changed significantly over the past decade. However, these changes did not keep pace with the rate of inflation. Plastic surgeons should be aware of these trends and advocate for more fair reimbursement rates.

Changes in Medicare Reimbursement for Commonly Performed Ophthalmic Procedures

Thirteen of the fifteen most commonly reported procedures in ophthalmology were subject to a statistically significant reduction in inflation-adjusted reimbursement from 2011 to 2020. A sustainable alternative to budget neutrality is critical.

Economic Evaluation of Changes in Reimbursement for Medications Purchased Through the 340B Drug Pricing Program.

Background: The Centers for Medicare and Medicaid Services (CMS) implemented changes to the reimbursement scheme for 340B-acquired medications on January 1, 2018, reducing payments by approximately 25%. It was recognized that these changes would have a significant fiscal impact to Medical University of South Carolina (MUSC) Health. The purpose of this assessment was to review the financial impact of changes in Medicare reimbursement for clinic-administered medications. Methods: This study was a single-center, retrospective, financial evaluation of closed outpatient encounters for Medicare beneficiaries in calendar year 2018. Actual reimbursement was calculated for 2018. To better characterize the margin obtained, exploratory analyses were completed to identify best- and worst-case reimbursement outcomes. This exploratory analysis was conducted for both the new (ASP-22.5%) and old (ASP+6%) reimbursement schemes. Results: Overall, 10 973 encounters were reviewed for inclusion. Ultimately, 8028 encounters were included in the final analysis. Of all encounters, 88 unique medications were administered. Most of the drugs (55%) were associated with oncologic indications. An unfavorable variance was found in 3761 encounters (47%). The actual reimbursement margin for 2018 was $3 193 525. Conclusion: Changes to reimbursement outlined by the CMS at the start of 2018 resulted in decreased reimbursement for 340B-eligible, clinic-administered medications. Most of the unfavorable variances were associated with 340B acquisition prices that exceeded reimbursement. Although the original intent of the 340B Drug Pricing Program was to stretch federal resources, decreased payments could reduce institutional ability to fund programs that support medically vulnerable populations.

Healing the poor: The influence of patient socioeconomic status on physician supply responses

A longstanding literature explores how altruism affects the way physicians respond to incentives and provide care. We analyze how patient socioeconomic status mediates these responses. We show theoretically that patient socioeconomic status systematically influences the way physicians respond to reimbursement changes, and we identify the channels through which these effects operate. We use two Medicare reimbursement changes to investigate these insights empirically. We confirm that a given physician facing an increase in reimbursement boosts utilization by more when treating richer patients. We show that average supply price elasticities vary from 0.02 to 0.18 for a given physician, depending on the patient’s socioeconomic status. Finally, we show that the Medicare reforms we study led to overall reimbursement increases that raised healthcare utilization by 10% more for high-income patients compared to their low-income peers.

The Historical Development of Value-Based Care: How We Got Here.

The original architects of Medicare modeled the payment system on the existing fee-for-service (FFS) structure that historically dominated the health-insurance market. Under the FFS paradigm, health-care expenditures experienced an exponential rise. In response, the managed care and capitation models of health-care delivery were developed. However, changes in Medicare reimbursement, along with an increasing volume of orthopaedic procedures and escalating implant costs, call into question the cost-effectiveness of this service line. The success of the Medicare Acute Care Episode (ACE) Demonstration Project proved the feasibility of value-based care and ushered in a new era of bundled payment initiatives.

Changes in Medicare Reimbursement for Advanced Upper Extremity Imaging

Advanced noninvasive imaging of the upper extremity joints, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) , has numerous applications in the evaluation of musculoskeletal pathology. Choice of modality is influenced by clinical and cost concerns, with US and CT traditionally considered less expensive than MRI. We analyzed the changes in Medicare reimbursement for these imaging modalities with the hypothesis that recent reimbursement decreases in MRI have made this modality more cost-competitive than other commonly used imaging modalities. Using the Medicare Fee Schedule Database, we reviewed the Medicare reimbursements fee schedule for CT, US, and MRI from 2000 to 2015 at the national, regional, and state levels. Charges were identified and queried by Common Procedural Terminology (CPT) codes for each modality. Changes in reimbursement were calculated for each of the modalities. Total (technical and professional) reimbursement for MRI decreased from $516.93 to $237.16 between 2007 and 2015. Adjusted for inflation, this represents a 60% decrease in reimbursement. During the same time period, total (technical and professional) reimbursement for CT decreased from $256.95 to $180.03, a 39% decrease adjusted for inflation. Total (technical and professional) reimbursement for US increased over the same time period, from $98.91 to $118.22 in 2015, in conjunction with changes in the CPT coding for US. Total (technical and professional) MRI reimbursement decreased from 5.23 times the reimbursement of US in 2007 to 2.01 times in2015. In concordance with our hypothesis, these findings demonstrate that upper extremity MRI and CT reimbursements as scheduled by Medicare have declined significantly in recent years and that these modalities are approaching financial parity with wrist US. In spite of these decreases, MRI remains the most costly advanced imaging modality. Depending on each clinical scenario, the added cost may be justified by the value added by the type of information that can be garnered from each study. Cost-analysis studies evaluating the clinical application of MRI performed prior to the reimbursement decline should be evaluated with caution, and cost-benefit analyses based on these data are at risk of being out-of-date. Economic Analysis IV.

The Role of Surgeon Technique in Current Practice Patterns for Combined Ptosis and Dermatochalasis.

The goal of this study is to identify and describe the role of surgical incision preference, insurance reimbursement, and geographical location on the current ptosis repair practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members. A 9-question survey was designed with surveymonkey.com and a participation link was emailed to all active ASOPRS members' email addresses in February 2015. After a reminder email, the survey was closed and the results were analyzed. There are 3 major questions the survey data is to be used answer: 1) Surgical approach preference: The first question established preferred surgical technique (internal vs. external approach) for ptosis repair. This result was/is used to stratify the remaining responses into 2 groups. 2) Functional versus cosmetic surgical indication: Three clinical scenarios were presented for a functional versus cosmetic patient for ptosis repair and blepharoplasty. 3) Location: The responses were analyzed based on location to determine any geographic bias for surgical preference. For this analysis, the US was separated into 4 regions (West, Midwest, North, and South), as defined by the United States Census Bureau; all international respondents were grouped together. Three hundred and ten responses were included and analyzed; 61% preferred the internal surgical approach, there was no statistical significance to geographic location (p = 0.17). Surgeons who prefer the external surgical approach (76.1%) were more likely than internal (62.5%) to include a bundled (nonreimbursed) blepharoplasty at no additional charge in the setting of functional ptosis repair (p = 0.015). Treatment plans differed significantly in both groups between functional and cosmetic patients with visually significant ptosis (Margin Reflex Distance < 1.5) and moderate dermatochalasis; with both the internal and external group electing combined surgery at a higher rate in cosmetic patients (p < 0.01 for functional vs. cosmetic within each group, and internal vs. external repair). There was no statistical difference in the timeframe for adjusting external ptosis for functional or cosmetic patients (p = 0.79). More surgeons use nonabsorbable closure for cosmetic blepharoplasty patients (68.7%) than for functional (54.1%) surgery patients (p < 0.01). Previous studies have documented the immediate effect of Medicare reimbursement changes on the management of concurrent ptosis and dermatochalasis. This study illustrates current practice patterns for ptosis repair and blepharoplasty. The necessity of creating a separate surgical site for surgeons who prefer the internal approach to ptosis surgery to perform a functional blepharoplasty has a significant influence on surgeon's willingness to perform concurrent blepharoplasty as a nonreimbursed bundled procedure.

Impact of consensus statements and reimbursement on vena cava filter utilization

Pulmonary embolism is the third most common cause of death in hospitalized patients. Vena cava filters (VCFs) are indicated in patients with venous thromboembolism with a contraindication to anticoagulation. Prophylactic indications are still controversial. However, the utilization of VCFs during the past 15years may have been affected by societal recommendations and reimbursement rates. The aim of this study was to evaluate the impact of societal guidelines and reimbursement on national trends in VCF placement from 1998 to2012. The National Inpatient Sample was used to identify patients who underwent VCF placement between 1998 and 2012. VCF placement yearly rates were evaluated. Societal guidelines and consensus statements were identified using a PubMed search. Reimbursement rates for VCF were determined on the basis of published Medicare reports. Statistical analysis was completed using descriptive statistics, Fisher exact test, and trend analysis using the Mann-Kendall test and considered significant for P< .05. The use of VCFs increased 350% between January 1998 and January 2008. Consensus statements in favor of VCFs published by the Eastern Association for the Surgery of Trauma (July 2002) and the Society of Interventional Radiology (March 2006) were temporally associated with a significant 138% and 122% increase in the use of VCFs, respectively (P= .014 and P= .023, respectively). The American College of Chest Physicians guidelines (February 2008 and 2012) discouraging the use of VCFs were preceded by an initial stabilization in the use of VCFs between 2008 and 2012, followed by a 16% decrease in use starting in March 2012 (P= .38). Changes in Medicare reimbursement were not followed by a change in VCF implantation rates. There is a temporal association between the societal guidelines' recommendations regarding VCF placement and the actual rates of insertion. More uniform consensus statements from multiple societies along with the use of level Ievidence may be required to lead to a definitive change in practice.

Increasing Vascular Access Options: AccuCath® IV Catheter System 2.25” Device Use Compared to PowerGlide™ Midline Catheter 3.1” Device

In response to Medicare reimbursement changes related to central line-associated blood stream infection (CLABSI) effective January 2011, a long-term acute care hospital implemented quality improvement measures to reduce these health care-associated infections. Improvements included alcohol-impregnated port protectors, chlorhexidine gluconate barrier dressings, and didactic/hands on training for care and maintenance. During 2010 the peripherally inserted central line (PICC) team at a neighboring Magnet hospital was asked to partner and develop strategies to further decrease CLABSI.The PICC team evaluated the effects of an antimicrobial PICC device in an effort to further reduce the incidence of CLABSI. Upon initiation of the evaluation phase, a database was created to track infection/thrombus rate, insertion-related complications, dwell time, diagnosis, tip location, infusate, vein used, and catheter size. Data collection and reporting was managed by the PICC team.Across a 2-year period (July 2011-July 2013), 100 devices were inserted with a total of 1,705 line days without any reported CLABSI. The majority of patients received a 4.5F single lumen device (59%). Dwell time ranged from 1 to 57 days with an average of 17 days. To date, no CLABSIs related to this device have been reported at the long-term acute care hospital.Based on 100 insertions yielding no infections this new product appears to improve patient safety and quality of care. Relative to these results sole use of this product has become their institutional standard for long-term intravenous needs.