Inflation-adjusted Reimbursement Research Articles

Regional Variation in Carpal Tunnel Release Utilization, Reimbursement, Practice Styles, and Patient Populations: A Temporal Analysis.

The purpose of this study was to evaluate changes in open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR) utilization, reimbursement, and patient demographics in the Medicare population from 2013 to 2021 at national and regional levels. The Medicare Physician & Other Practitioners database from 2013 to 2021 was queried to extract all instances of OCTR and ECTR. Utilization per 10,000 beneficiaries, inflation-adjusted reimbursement, and patient characteristics were extracted for OCTR and ECTR each year. Data were stratified by region based on US Census guidelines. Kruskal-Wallis tests and multivariable linear regressions were performed. From 2013 to 2021, national utilization per 10,000 beneficiaries increased by 6% for OCTR and by 50% for ECTR. In 2021, the Midwest had the greatest utilization of OCTR (29 of 10,000) and the lowest utilization of ECTR (7 of 10,000). Inflation-adjusted reimbursement declined for both OCTR and ECTR during the study period (10.3% and 11.8%, respectively), with the South having the lowest reimbursement for both procedures. The severity of patient comorbidity profiles and dual Medicare-Medicaid enrollees decreased for both procedures as well. Both OCTR and ECTR utilization have increased, while inflation-adjusted reimbursement has decreased. Patient populations encompassed fewer dual Medicare-Medicaid enrollees, indicating surgeons may be more selective in operative indications. These findings should be addressed to ensure the economic sustainability of carpal tunnel release procedures and equitable access to quality hand care for all patients with Medicare. [Orthopedics. 2025;48(1):e45-e51.].

Differences in Reimbursements, Procedural Volumes, and Patient Characteristics Based on Surgeon Gender in Total Hip Arthroplasty

BackgroundPrior studies have suggested there may be differences in reimbursement and practice patterns by gender. The purpose of this study was to comprehensively evaluate differences in reimbursement, procedural volume, and patient characteristics in total hip arthroplasty (THA) between men and women surgeons from 2013 to 2021. MethodsThe Medicare Physician and Other Practitioners database from 2013 to 2021 was queried. Inflation-adjusted reimbursement, procedural volume, surgeon information, and patient demographics were extracted for surgeons performing over 10 primary THAs each year. Wilcoxon, t-tests, and multivariate linear regressions were utilized to compare men and women surgeons. ResultsOnly 1.4% of THAs billed to Medicare between 2013 and 2021 were billed by women surgeons. Men surgeons earned significantly greater reimbursement nationally in 2021 compared to women surgeons per THA ($1,018.56 versus $954.17, P = .03), but no difference was found when assessing each region separately. Reimbursement declined at similar rates for both men and women surgeons (−18.3 versus −19.8%, P = .38). An increase in the proportion of women surgeons performing THA between 2013 and 2021 was seen in all regions except the South. In 2021, the proportion of all THAs performed by women surgeons was highest in the West (3.5%) and lowest in the South (1.0%). Women surgeons had comparable patient populations in terms of age, race, comorbidity status, and Medicaid eligibility to their men counterparts, but performed significantly fewer services per beneficiary (5.6 versus 8.1, P < .001) and fewer unique services (51.1 versus 69.6, P < .001). ConclusionsAverage reimbursement per THA has declined at a similar rate for men and women physicians between 2013 and 2021. Women’s representation in THA surgery nationwide has nearly doubled between 2013 and 2021, with the greatest increase in the West. However, there are notable differences in billing practices between genders.

Medicare Volume Growth and Shift in Payments From Physicians to Non-Physician Practitioners Under Statutory Budget Neutrality

Volume increases, inflation, statutory freezes in physician payments, and the budget neutrality requirement for the Medicare Physician Fee Schedule have resulted in persistent inflation-adjusted conversion factor decreases. This study aimed to determine if relative value unit (RVU) volume increases on a per beneficiary basis has counteracted conversion factor decreases and inflation to maintain Medicare reimbursement per beneficiary, overall and across specialties. Using aggregated data for 100% of Medicare part B claims (2005-2021), we computed the percentage change in reimbursement per beneficiary, nominal and inflation-adjusted, by specialty. These trends were then adjusted by separately holding constant RVUs per beneficiary and the conversion factor to demonstrate the impact of budget neutrality. Inflation-adjusted reimbursement per beneficiary increased 9.9% over the 2005 to 2021 period; this trend encapsulated a 64.8% increase in RVUs per beneficiary, offsetting a 33.6% inflation-adjusted conversion factor decline. RVU changes per beneficiary varied widely across clinicians (+45.5% for physicians to +328.2% for non-physician practitioners) and by specialty (−36.1% for cardiac surgery to +1106% for nurse practitioners). Given RVU increases, conversion factor decreases, and inflation combined, reimbursement per beneficiary decreased 2.3% for physicians and increased 16.3% for limited-license physicians and 206.5% for non-physician practitioners. Overall, increased RVU volume per beneficiary has offset conversion factor declines within the budget neutral system. However, substantial redistribution has occurred across provider types, with reimbursement declining slightly for physicians while tripling for non-physician practitioners. Certain physician specialties, particularly procedural specialties, have declined most. Future research should assess the impact of specialty-specific reimbursement changes on patients’ access to care.

106 Reimbursement Trends in Neuroendovascular Interventions 2013-2022

INTRODUCTION: Neuroendovascular surgeries are increasingly important, particularly with the advent of thrombectomy as the gold standard in the management of large vessel stroke. METHODS: The Physician Fee Schedule Look-Up Tool was queried from 2013 to 2019 for all primary Current Procedural Terminology (CPT) codes identified by the American Medical Association as pertaining to endovascular procedures of the nervous system (61623, 61624, 61630, 61635, 61626, 61645, and 61650). The facility prices were averaged for each procedure and subsequently adjusted for inflation using the United States Bureau of Labor Statistics’ Consumer Price Index Inflation Calculator as adjusted to January of 2022. Statistical analyses, including data aggregation, exploratory analysis, and propensity adjustment, were performed using R, version 4.0.1 (The R Foundation, Vienna, Austria). The two-sided Mann-Kendall trend test, a non-parametric statistical test that assesses for monotonic trends in either an upward or downward trend, was utilized to assess for trends over time. Within each year analyzed, a Chi-squared test for trend in proportions was used. A significance level of 0.05 was used. RESULTS: Decreases in reimbursement were noted for all neuroendovascular procedures. This trend was statistically significant for temporary balloon occlusion, CPT61623 (2013:$677.04; 2022:586.96; p: 0.01), central nervous system transcatheter permanent occlusion or embolization, CPT61624 (2013:$1349.61; 2022:$1175.02; p: 0.02), non-central nervous system transcatheter permanent occlusion or embolization, CPT61626 (2013:$1040.86; 2019:$912.29; p: 0.002), stent placement, CPT61635 (2013:$1697.18; 2022:$1490.68; p: 0.05), and when viewed as aggregate procedures (2013:$1265.01; 2022:$1000.45; p &lt; 0.01). CONCLUSIONS: Inflation-adjusted reimbursement is decreasing for certain neuroendovascular procedures over time and for all neuroendovascular procedures when viewed as an aggregate group. This suggests a need for reevaluation of the market value and advocacy for neuroendovascular providers and procedures in the era of value/quality-based care.

Are Cervical Disc Arthroplasty Medicare Reimbursement Trends Sustainable?

Cervical disc arthroplasty (CDA) was originally approved by the US Food and Drug Administration (FDA) in 2007 as a motion-sparing procedure to treat cervical degenerative disc disease. Since then, promising results from randomized control trials have led to increasing popularity. However, data discussing monetary trends are limited. The aim of this study was to determine how utilization, hospital charges, and Medicare physician reimbursement for CDA have changed over time. In this retrospective cohort study, International Classification of Diseases procedure codes were used to identify all patients who underwent CDA from 2007 to 2017 in the National Inpatient Sample database. The Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services was queried for primary CDA using current procedural terminology codes to determine Medicare physician reimbursement from 2009 to 2021. Nominal monetary values were adjusted for inflation using the Consumer Price Index and inflation-adjusted data reported in 2021 US dollars. A total of 33,079 weighted patients who underwent CDA were included for analysis. CDA utilization increased by 183% from 2007 to 2017, with Medicare beneficiary utilization increasing 149%. Inflation-adjusted total hospital charges for CDA increased by 22.4%. However, inflation-adjusted Medicare physician reimbursement fell by 1.20% per year, demonstrating a total decrease of 12.9%, starting at $1928 in 2009 and declining to $1679 in 2021. While utilization and total hospital charges for CDA continue to rise, Medicare physician reimbursement has not shown the same trend. In fact, inflation-adjusted reimbursement has seen a steady decline since FDA approval in 2007. If this trend persists, it may become unsustainable for physicians to continue offering CDA to Medicare patients. As disproportionate increases in hospital charges incentivize a transition to outpatient CDA, stricter patient selection criteria associated with outpatient procedures may create health care disparities for Medicare patients and those with higher comorbidity burden. This study shows the decreasing reimbursement trends for CDA, which may disproportionately affect Medicare patients and those with increased comorbidities.

Physician Reimbursement for Vascular Surgery Procedures and Vascular Laboratory Studies Before and After the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA), fully implemented by 2015, has significantly increased the number of Americans with health insurance. However, its impact on physician reimbursement (PR) is not well studied. Our objective was to determine the ACA's impact on the professional component of PR for selected vascular surgery (VS) procedures and vascular laboratory (VL) studies at our institution. PR for the following 5 VS procedures and 4 VL studies were obtained from our billing department: CPT 34803 (Endovascular aortic repair, EVAR), 35301 (carotid endarterectomy, CEA), 35656 (lower extremity bypass, LEB), 36010 (introduction of catheter into vena cava, ICVC), 36200 first, 93922 (ankle brachial index, ABI), 93925 (lower extremity arterial duplex, LEA duplex), 93970 (lower extremity venous duplex, LEV Duplex), and 93990 (hemodialysis duplex). The data was organized by payer: Medicare, Medicaid, Commercial Insurers (CI), and Other. PR was studied pre-ACA (January 2008 through December 2009) and post-ACA (January 2015 through December 2016). The post-ACA PR and inflation adjusted reimbursement (IAR) in 2016 dollars using the consumer price index (CPI) were calculated and compared using one-sample t-test. The percent difference between the post-ACA PR and IAR was also compared. PR for 1,637 VS procedures and 16,333 VL studies was analyzed. The post-ACA PR was significantly lower than the IAR for most Medicare and Medicaid procedures. For EVAR, post-ACA reimbursement was overall on par with the IAR but significantly lower for Medicare. For CEA, post-ACA reimbursement was overall lower than IAR. For LEB, overall average PR was lower than IAR, with statistically significant lower Medicare and Medicaid (P < 0.001) payments. For ICAo, overall PR was significantly lower than the IAR and this was true across all insurance types. In contrast, for ICV, the post-ACA reimbursement was higher than IAR for all payers but did not reach statistical significance (P=0.25). The post-ACA PR was significantly higher than the IAR for most VL studies, except for Medicare PR. The percent change for VS procedures were mostly negative for the Medicaid and Medicare groups. This results in potential annual shortcomings of $2, 862 and $20,923 respectively. When comparing reimbursement before and after ACA implementation, Medicare and Medicaid PR for most VS procedures has not kept up with inflation. However, for most VL procedures, PR has exceeded inflation. Further efforts are needed to support Vascular Surgery reimbursement including higher valuation of the Medicare Conversion factor.

Procedure Reimbursement, Inflation, and the Declining Buying Power of the Vascular Surgeon (2011-2021)

The purpose of this study was to evaluate trends in Medicare reimbursement for common vascular procedures over the last decade. To enrich the context of this analysis, vascular procedure reimbursement is directly compared to inflation-adjusted changes in other surgical specialties. The Centers for Medicare & Medicaid Services Physician/Supplier Procedure Summary file was utilized to identify the 20 procedures most commonly performed by vascular surgeons from 2011-2021. A similar analysis was performed for orthopedic, general, and neurological surgeons. The Centers for Medicare & Medicaid Services Physician-Fee Schedule Look-Up Tool was queried for each procedure, and reimbursement data was extracted. All monetary data was adjusted for inflation to 2021 dollars utilizing the consumer price index. Average year-over-year and total percentage change in reimbursement were calculated based on adjusted data for included procedures. Comparisons to other specialty data were made with ANOVA. From 2011-2021, the average, unadjusted change in reimbursement for vascular procedures was -7.2%. Accounting for inflation, the average procedural reimbursement declined by 20.1%. The greatest decline was observed in phlebectomy of varicose veins (-50.6%). Open arteriovenous fistula revision was the only vascular procedure with an increase in inflation-adjusted reimbursement (+7.5%). Year-over-year, inflation-adjusted reimbursement for common vascular procedures decreased by 2.0% per year. Venous procedures experienced the largest decrease in average adjusted reimbursement (-42.4%), followed by endovascular (-20.1%) and open procedures (-13.9%). These changes were significantly different across procedural subgroups (P < 0.001). During the same period, the average adjusted change in reimbursement for the 20 most common procedures in orthopedic surgery, general surgery, and neurosurgery was -11.6% vs. -20.1% for vascular surgery (P = 0.004). Medicare reimbursement for common surgical procedures has declined over the last decade. While absolute reimbursement has remained relatively stable for several procedures, accounting for a decade of inflation demonstrates the true diminution of buying power for equivalent work. The most alarming observation is that vascular surgeons have faced a disproportionate decrease in inflation-adjusted reimbursement in comparison to other surgical specialists. Awareness of these trends is a crucial first step towards improved advocacy and efforts to ensure the "value" of vascular surgery does not continue to erode.

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.

Trends in Medicare Reimbursement: Analysis of Prostate IMRT and Breast 3D-CRT Fees from 2011-2019

Passage of the Affordable Care Act (ACA) in 2010 drew national attention to the need to reduce healthcare costs. In July of 2018, the Centers for Medicare and Medicaid Services (CMS) announced a proposal to reduce payments for radiation oncology services by 2% in 2019. This prompted resistance from the radiation oncology community, yet the context for this 2019 proposal is poorly understood. The goal of this study is to explore historical trends in Medicare reimbursement rates in radiation oncology since the passage of the ACA in 2010, for several of the most commonly prescribed radiation therapy treatments. Process maps modeled each step in treatment of 4 different types of radiation therapy: conventionally-fractionated 3-D whole breast irradiation (CF-WBI, 25 fractions + 5 fraction boost), hypofractionated 3-D whole breast irradiation (HF-WBI, 16 fractions + 4 fraction boost), conventionally fractionated prostate IMRT (CF-P, 39 fractions), and hypofractionated prostate IMRT (HF-P, 20 fractions). Reimbursement rates were determined from the 2019 CMS Medicare Physician Fee Schedule (MPFS) database. Annual Inflation rate from 2011 to 2018 was obtained from the Federal Reserve Bank. Inflation-adjusted reimbursement was determined for each treatment modality from 2011 to 2019 and reported in 2019 dollars. Each of the 4 treatment techniques demonstrated decline in inflation-adjusted reimbursement from 2011 to 2019. HF-WBI inflation-adjusted reimbursement decreased from $9,333 in 2011 to $9,162, representing mean annual decrease (MAD) and total decreases (TD) of 0.1% and 1.8% respectively. CF-WBI reimbursement decreased from $12,575 to $12,405 (MAD 0.1%, TD 1.3%). HF-P reimbursement decreased from $21,637 to $14,386 (MAD 4.8%, TD 33.5%) and CF-P reimburse decreased from $38,240 to $24,710 (MAD 5.2%, TD 35.4%). The large decline in prostate IMRT reimbursement was predominantly due to decrease in the fee for treatment delivery, which accounted for 70.7% and 71.5% of the drop for HF-P and CF-P respectively. Since passage of the ACA in 2010, inflation-adjusted Medicare reimbursement for prostate IMRT and breast 3D-CRT have decreased. While breast 3D-CRT has shown a modest average drop of 0.1% per year, average prostate IMRT reimbursements have dramatically decreased, approximately 5% per year, representing a total decrease of over 30% over the past 8 years. These declines in Medicare reimbursement, combined with increasing pressures to move towards hypofractionation, creates a "double-hit” effect. Prostate IMRT reimbursement is diminished due to both a lower number of billable treatments and decreased reimbursement per treatment. This places significant financial pressure on radiation oncology practices. Not only is there a disincentive for hypofractionated treatment, but with decreasing revenues, departments may face a choice of reducing salaries or staffing levels, delaying equipment purchases, or cutting research support.