Reimbursement For Procedures Research Articles

071 Decreasing Medicare Reimbursement for Men's Health Procedures: 2002-2020

071 Decreasing Medicare Reimbursement for Men's Health Procedures: 2002-2020

An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019.

Medicare reimbursement trends across multiple surgical subspecialties have been analyzed; however, little has been reported regarding the long-term trends in reimbursement of hand surgery procedures. The aim of this study is to analyze trends in Medicare reimbursement for commonly performed hand surgeries. Using the Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File, we determined the 20 hand surgery procedure codes most commonly billed to Medicare in 2016. Reimbursement rates were collected and analyzed for each code from The Physician Fee Schedule Look-Up Tool for years 2000 to 2019. We compared the change in reimbursement rate for each procedure to the rate of inflation in US dollars, using the Consumer Price Index (CPI) over the same time period. The reimbursement rate for each procedure increased on average by 13.9% during the study period while the United States CPI increased significantly more by 46.7% (P < .0001). When all reimbursement data were adjusted for inflation to 2019 dollars, the average reimbursement for all included procedures in this study decreased by 22.6% from 2000 to 2019. The average adjusted reimbursement rate for all procedures decreased by 21.92% from 2000 to 2009 and decreased by 0.86% on average from 2009 to 2019 (P < .0001). When adjusted for inflation, Medicare reimbursement for hand surgery has steadily decreased over the past 20 years. It will be important to consider the implications of these trends when evaluating healthcare policies and the impact this has on access to hand surgery.

Changes in Medicare Physician Reimbursement for Stroke Procedures from 2000 to 2019

ABSTRACT BACKGROUND There is limited data regarding financial trends for procedural reimbursement in stroke care. A comprehensive understanding of such trends is important as continued progress is made to advance agreeable reimbursement models in the care of stroke patients. OBJECTIVE To evaluate monetary trends in Medicare reimbursement rates for commonly utilized procedures in stroke care from 2000 to 2019. METHODS The Centers for Medicare &amp; Medicaid Services was queried for the included Current Procedural Terminology (CPT) codes and reimbursement data were extracted. The CPT codes compiled were the most commonly performed procedures for stroke-related International Classification of Diseases (ICD)-10 codes at our institution (I60-I63). Additionally, data were collected for alteplase and telestroke codes. The rate of change between procedures was compared utilizing an unpaired Student's t-test. All monetary data were adjusted for inflation to 2019 US dollars utilizing the US Consumer Price Index. RESULTS After adjusting for inflation, the average reimbursement for stroke (ICD I60-I63) procedures decreased by 11.2% from 2000 to 2019 (average of −0.43% per year). The adjusted reimbursement rate for included telestroke codes decreased by 12.1% from 2010 to 2019 (average of −1.4% per year). From 2005 to 2019, the reimbursement for alteplase rose by 163.98% (average of +7.3% per year). CONCLUSION When adjusted for inflation, Medicare reimbursement for common stroke procedures has decreased from 2000 to 2019. In contrast, reimbursement for alteplase has increased markedly. It is important to be aware of these trends in order to contextualize healthcare economic analyses and inform discussions.

Procedure Reimbursement, Inflation, and the Declining Buying Power of the Vascular Surgeon (2011-2019)

Procedure Reimbursement, Inflation, and the Declining Buying Power of the Vascular Surgeon (2011-2019)

Medicare Reimbursement Trends for Interventional Radiology Procedures: 2012 to 2020

PurposeTo investigate the reimbursement trends for interventional radiology (IR) procedures from 2012 to 2020. Materials and MethodsReimbursement data from the Physician Fee Schedule look-up tool from the Centers for Medicare and Medicaid Services was compiled for 20 common IR procedures. The authors then investigated compensation trends after adjusting for inflation and from the unadjusted data between 2012 and 2020. ResultsFrom 2012 to 2020, the mean unadjusted reimbursement for procedures decreased by −6.9% (95% confidence interval [CI], −13.5% to −0.34%). This trend was even more profound after inflation was taken into account, with a mean decline in adjusted reimbursement of −18.7% (95% CI, −24.4% to −12.9%) during the study period, with a mean yearly decline of −2.8%. The difference between the mean unadjusted and adjusted payment amounts was significant (P = .012). Similarly, linear regression analysis of the adjusted average reimbursement across all procedures revealed an overall decline from 2012 to 2020 (R2 = 0.97), indicating a steady decline in reimbursement over time. ConclusionsIn just under a decade, IR has experienced significant reimbursement cuts by Medicare, as demonstrated by both the unadjusted and inflation-adjusted payment trends. Knowledge of these trends is critically important for practicing interventional radiologists, leaders within the field, and legislators, who may play a role in formulating future reimbursement schedules for IR. These data may be used to help support more amenable reimbursement plans to sustain and facilitate the growth of the specialty.

A comparison of mixture cure fraction models to traditional parametric survival models in estimation of the cost-effectiveness of nivolumab for relapsed small cell lung cancer

Background In August 2018, the US FDA granted accelerated approval for nivolumab in small cell lung cancer (SCLC) that has progressed after platinum-based chemotherapy and at least one other line of therapy. The objective of this study was to evaluate the cost-effectiveness of nivolumab vs. usual care as third-line (3 L) therapy for patients with recurrent SCLC (rSCLC) from the health payer perspective. Given the potential for a meaningful fraction of treated patients to achieve long-term response to nivolumab, we also assessed the impact of using mixture cure modeling (MCM) vs. parametric survival modeling on survival estimates and cost-effectiveness from the US Medicare payer perspective. Methods We created a partitioned survival decision model to assess the cost-effectiveness of 3 L nivolumab vs. usual care in rSCLC, based on observed US treatment patterns. Using this approach, we assessed the impact of extrapolating long-term survival from the CheckMate 032 trial, using both MCM and standard parametric curve fits. Nivolumab survival, resource use, and Grade 3/4 adverse event rates were derived from CheckMate 032. Usual care survival, resource use, and costs were derived from an analysis of patients receiving 3 L treatment for rSCLC in the SEER-Medicare registry. We applied 2020 Wholesale Acquisition Cost for drugs and 2020 CMS reimbursement for procedures. Utilities were derived from the literature. We estimated life years (LY), quality-adjusted life years (QALYs), and costs over a lifetime horizon. Results MCM and parametric survival model extrapolations resulted in 0.43 versus 0.38 more LYs, 0.34 versus 0.30 more QALYs, and $69,308 versus $61,336 more expenditure for nivolumab vs. usual care, respectively. The costs per QALY gained using mixture cure versus parametric survival modeling were $204,386 and $207,431, respectively. Conclusions Mixture cure modeling was equivalent compared to parametric modeling in estimating the cost-effectiveness of nivolumab-based therapy due to the small fraction of patients achieving a long-term response with nivolumab (12.9%).

Trends in Medicare Reimbursement for Otology Procedures From 2000 to 2020.

The purpose of this study is to investigate the Medicare reimbursement trends for otologic procedures from 2000 to 2020. Retrospective data analysis using the Physician Fee Schedule Look-Up tool from the Centers for Medicare and Medicaid services. Facility performed procedures of the auditory system. Medicare beneficiaries from 2000 to 2020. Selected otologic current procedural terminology codes and their respective year-to-year reimbursement data. Assessment of trends in financial reimbursement. After adjusting for inflation, the total average reimbursement for all procedures saw an average decrease of -21.2% from 2000 to 2020. The average adjusted percent change per year was -1.3% indicating a slow decline in reimbursement over the study period. There was a difference between the adjusted and unadjusted percent change in reimbursement rate during the study period (-21% versus 20.4%, respectively; p < 0.001). Linear regression analysis of the adjusted average reimbursement across all procedures revealed an overall decline from 2000 to 2020 with an R-squared value of 0.85 indicating a decline in reimbursement over time. After adjusting all data for inflation, there has been a reduction in the average Medicare reimbursement for otology procedures from 2000 to 2020. Compared with previous reimbursement studies on the whole field of otolaryngology, otology has a less severe decline in reimbursement. Knowledge of these reimbursement trends is critical for otologic surgeons and leaders within the field to develop more sustainable reimbursement plans.

Is the current insurance structure leading to seasonality in demand for spinal surgery? A quarterly, yearly, and insurance based analysis

BackgroundElective lumbar fusion is a commonly employed procedure for degenerative lumbar spine disease. With healthcare costs rising reimbursement for procedures may be restricted by payers. Additionally, patients may undergo elective fusion once deductibles are covered, typically in the fourth quarter in a given year. The objective of this study was to analyze the trends in utilization for posterior lumbar fusion (PLF) earlier in the year (Q1-Q3) as compared to the end of the year(Q4). Variations in this proposed trend by insurance type were also studied as a primary outcome. MethodsWe queried the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS) between January 1, 2012 and December 31, 2014 for patients diagnosed with lumbar disc degenerative disease (DDD). Outcomes of interest included utilization and frequency of PLF. Results221,466 patients hospitalized with Lumbar DDD between 2012 and 2014 were identified. Of these, 67,343(30.4 %) underwent a PLF procedure. The likelihood of lumbar fusion in patients hospitalized with DDD was significantly higher in the 4th quarter, compared to 1st quarter (OR1.13, p < 0.001). Marginal effect analysis indicated that Medicare patients were 1.0 % more likely to undergo PLF in quarter 4 compared to quarters 1−3 (p = 0.003), while privately insured patients were 2.5 % more likely to undergo PLF in quarter 4 compared to quarters 1-3(p < 0.001). ConclusionThese results indicate that utilization of PLF is higher at the end of the year relative to the beginning, especially for patients with private insurance. This may be due to deductibles that have previously been paid off, lowering out-of-pocket expenses.

Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

BackgroundTwo of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks. This paper seeks to examine whether the type of health insurance enrollment affects the utilization of health services, choice of provider and financial protection of households in Togo.MethodsData were obtained from a cross-sectional, representative household survey involving 1180 insured households that had reported either illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. A nested logit model was used to account for the utilization of health services and provider choice, and methods of assessing catastrophic health care expenditures were used to analyze the level of household financial protection.ResultsPolicyholders of private health insurance use private health care facilities more than policyholders of public health insurance. The main reasons for not using health centers among households with public insurance were out-of-pocket payments (49.19%), waiting time (36.80%), and distance to the nearest health center (36.76%). Furthermore, on average, households with public insurance spent a higher proportion of their total monthly nonfood expenditures on health care than those with private insurance. We find that the type of insurance, share of expenditures allocated to food, distance to the nearest health center, and waiting time significantly impact the choice of provider. Regardless of the type of health insurance, elderly individuals avoid using private health centers and referral hospitals due to the high cost.ConclusionWe found that a multiple health insurance system results in a multilevel health system that is not equitable for everyone. The capacity of the health insurance system to provide equitable health care services and protect its members from catastrophic health care expenditures should be at the core of health care reform. This study recommends raising awareness of the criteria for the reimbursement of medical procedures within the framework of public insurance and promoting specific health insurance mechanisms for elderly individuals. Careful attention should be paid to ensuring universal education and literacy as a means of improving access to and the use of health care.

Robotic vs. open surgery in obese women with low-grade endometrial cancer: comparison of costs and quality of life measures

BackgroundThis retrospective study compared perioperative measures, costs, quality of life and survival after open vs. robotic surgery, among obese women diagnosed with low-grade endometrial cancer.MethodsObese women (body mass index (BMI) ≥ 30) who underwent open or robotic surgery for endometrial cancer, in one of two tertiary medical centers in the center of Israel, 2013–2016, postoperative grade 1–2, were included. Costs per patient, including 30-days post-surgery were calculated. Quality of life was evaluated by Physical and Mental Components of the SF-36 and a recovery from surgery questionnaire. Overall survival outcomes were obtained from patients’ files. Surgical outcomes, including operating and anesthesia times, length of hospital stay, and intraoperative and postoperative complications according to the Clavien-Dindo classification scale were reviewed.ResultsIn all, 138 women with BMI ≥30 underwent open (n = 61) or robotic surgery (n = 77) during the study period. The groups had similar BMI, comorbidities, demographics and tumor characteristics. Robotic surgery was associated with shorter hospital stays (mean 1.7 vs. 4.8 days; P < .0001) and fewer postoperative complications (Clavien-Dindo > 2, 5.2% vs. 19.7%; P = .0008), but longer operating theater time (3.8 vs. 2.8 h; P < .001). Costs are equivalent when at least 350 robotic surgeries are performed annually, not including the initial system costs. Quality of life measures were better after robotic surgery. SF-36 showed better measures for robotic surgery (Physical 56 vs. 39 and Mental 73 vs. 56; P < .01). After robotic surgery, patients tended to recover quicker when compared to open surgery, as they returned to normal activities earlier, with less need for family and governmental assistance (mean recovery time, 23 vs. 70 days; P < 0.006 and mean change in preoperative total functioning score, − 1.5 vs. -3.9: P < 0.05, respectively). Overall, 5-year survival was 89.8% for the open surgery group vs. 94% for the robotic surgery group (log rank, P = 0.330).ConclusionsObese women with low-grade endometrial cancer had better quality of life after robotic vs. open surgery. They also had shorter hospital stays and fewer postoperative complications. Centers with high volumes of robotic surgery can achieve similar costs when comparing both methods. These results were achieved without jeopardizing survival. Our results further emphasize the need for the Israeli healthcare system to include specific reimbursement for robotic procedures in the population we studied.

A Comparison of Hysterectomy and Prostatectomy Medicare Reimbursement Rates: 2010-2019

Study Objective To investigate differences in Medicare reimbursement rates between hysterectomy and prostatectomy to understand gender disparities in healthcare reimbursement. Design Ten codes representing hysterectomy and five codes representing prostatectomy from The Physician Fee Schedule Look-Up Tool. Setting Centers for Medicare & Medicaid Services. Patients or Participants All patients who had undergone hysterectomy or prostatectomy with reimbursement by Medicare using the fifteen codes represented in The Physician Fee Schedule Look-Up Tool from 2010-2019 in the United States. Interventions Hysterectomy or prostatectomy reimbursed by Medicare. Measurements and Main Results The codes were identified and the average annual and total percent change in reimbursement were calculated from 2010 to 2019. After adjusting for inflation, the average reimbursement for abdominal hysterectomy procedures decreased by 7.85% and for laparoscopic hysterectomy procedures by 21.16% with average R2 values of 0.94 and 0.88, respectively. The average reimbursement for open prostatectomy procedures decreased by 23.61% and by 28.20% for laparoscopic prostatectomy procedures with average R2 values of 0.86 for both. The average reimbursement rate in dollar amount for abdominal hysterectomy is $1068.68 and $1,374.25 for open prostatectomy. The average reimbursement rate in dollar amount for laparoscopic hysterectomies and prostatectomies are $1,053.32 and $1,775.65, respectively. Conclusion This study provides an analysis of trends in procedural Medicare reimbursement for hysterectomy procedures and prostatectomy procedures. Medicare reimbursement rates for hysterectomies have decreased by a smaller amount than prostatectomy procedures, although average reimbursement for hysterectomy procedures still remains lower. Reimbursement for procedures are calculated based on multiple factors, but gender equity should be an important factor for policy makers. Results from this study show that while male-specific procedures are still reimbursed more, there is a more rapid decline in reimbursement rates for male-specific procedures, potentially signaling movement towards greater equality. Further work must be done to understand why inequalities still exist in the medical field regarding reimbursement for sex-specific procedures.

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

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.

Trends of Breast Reconstruction in Medicare Beneficiaries

BACKGROUND: In April 2014, the Centers for Medicare and Medicaid Services released millions of billing records for over 880,000 healthcare providers in an effort to improve the transparency, accountability, and affordability of the US healthcare system. This study was performed to analyze the overall Medicare landscape with respect to surgeons, beneficiaries, services, and reimbursements in the setting of breast reconstruction. METHODS: This is a retrospective analysis of publicly available Medicare utilization and payment data for surgeons who provided services to Medicare beneficiaries between January 2012 and December 2017. Breast reconstruction Current Procedural Terminology (CPT) codes were queried using the Medicare Payment and Utilization Database. Statistical significance was computed using a one-way analysis of variance and Levene’s test was used to confirm the homogeneity of variances. RESULTS: Data included trends in the number of breast reconstructions over time and average Medicare reimbursements over time. In general, the number of breast reconstructions increased over the study period, with the greatest increase in free flap breast reconstruction (+55.5%) and the greatest decrease in TRAM reconstruction (−36.9%). On average, the Medicare payment amount per service was about 20% of the submitted charge. For example, reconstruction with latissimus flap charge in 2017 was $6,588 and payment amount was $1,358, resulting in a 79.4% reduction. Despite inflation and overall increases in healthcare costs, reimbursements in breast reconstruction have had little or no increase over time. The highest rate of change was Current Procedural Terminology 19366 (breast reconstruction with other technique), which increased from $957 in 2012 to $1,136 in 2017, for an +18% rate of change. Over the study interval, implant-based reconstruction increased around 12%, whereas latissimus and free flap reconstruction decreased around 2% over the same time interval. CONCLUSION: Our study identifies and quantifies wide variations in reimbursement for breast reconstruction procedures. Over the study period, reimbursement for implant-based reconstruction increased while autologous reconstruction decreased. Variations in reimbursement may preclude some surgeons from offering certain reconstructive options to a subset of patients. Addressing these potential care disparities in a growing patient population has major implications in quality of care for a large subset of women recovering from breast cancer. It is important for surgeons to understand these trends and to communicate with policy makers toward developing sustainable reimbursement models.

Assessment of Intraoperative Time for Head and Neck Cancer Surgeries Compared With Medicare Work Time

Surgeon reimbursement is dictated in part by the operative time necessary to complete a procedure. The purpose of this study is to compare insurer-set time to true intraoperative time for common head and neck cancer procedures. This retrospective cohort study compares intraoperative times between the 2019 Center for Medicare and Medicaid Services (CMS) work-time estimates and the 2017 to 2018 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data sets for 10 commonly billed head and neck cancer procedures. The primary predictor variable was common head and neck oncologic and reconstructive procedures with corresponding Current Procedural Terminology (CPT) code. The primary outcome variable includes the computed difference between CMS and NSQIP times. Additional variables collected include patient demographics (gender, age, race, and inpatient/outpatient) and work relative value unit (wRVU) per CPT code. Analysis of variance was used to evaluate differences in intraoperative times across CPT codes. Linear regression using standardized coefficients were calculated between CMS time and NSQIP time; CMS time and wRVUs; and NSQIP time and wRVUs. There were 8,330 subjects (44% female, 57.7% inpatient) across 10 CPT codes. Analysis of variance revealed intercode variability in median intraoperative times between CMS and NSQIP (P<.001). CMS underestimated the time necessary to complete excision of malignant tumor mandible (CPT 21045) by 315minutes. CMS overestimated the time necessary for excision of tongue lesion (CPT 41112) by 5minutes. Overall, CMS intraoperative time estimates were neither invariably longer nor consistently shorter than NSQIP procedural times (β, 0.85; 95% confidence interval, 0.43 to 1.26). CMS estimates of time needed to complete head and neck cancer surgeries varies from national intraoperative times. No consistent trend in underestimation or overestimation of procedure time was found. Improving the accuracy of CMS time estimates used in determining surgeon reimbursement for head and neck cancer procedures may be warranted.

Reimbursement for therapeutic apheresis devices and procedures for using the healthcare insurance system in Japan.

The aim of this paper was to explain the insurance coverage status of therapeutic apheresis (excluding CHDF) in Japan, alongside the social system of medical reimbursement and concerns regarding the future sustainability of the healthcare system. Insurance schemes and premiums differed for individuals at different levels in the society (eg, municipal residents, employees, and public servants). Insurance premiums and their rates varied depending on the total household income, the number of people living together, age, and the place of residence. In addition, the medical expense subsidies for children through public expenditure were also described. Japan's generous insurance system and multiple medical expense subsidies provide financial support for patients. With Japan's history of medical expense subsidies based on the policy of supporting intractable diseases, we have established an environment where all citizens can receive therapeutic apheresis when needed if they are affected by a disease for which insurance coverage is indicated.

Is the New Outpatient Prospective Payment System Classification for Outpatient Total Knee Arthroplasty Appropriate?

BackgroundIn 2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the inpatient-only list, resulting in payment through the Outpatient Prospective Payment System with an average $3157 reduction. The purpose of this study is to determine if the reimbursement is justified by comparing the difference in facility costs between inpatient and outpatient TKAs. MethodsWe identified 4496 consecutive primary TKA procedures performed at 2 hospitals from 2015 to 2019. Itemized facility costs were calculated using a time-driven activity-based costing algorithm. Outpatient procedures were defined as those with a length of stay of less than 2 midnights (3851, 86%). Patient demographics, comorbidities, and itemized costs were compared between groups. A multivariate regression analysis was performed to determine the independent effect of outpatient status on true facility costs. ResultsOutpatient TKA patients had lower mean postoperative personnel costs ($1809 vs $947, P < .001), supply costs ($4347 vs $4229, P < .001), and overall total facility costs ($7371 vs $6937, P < .001) than inpatient TKA patients. Controlling for a younger patient cohort with fewer medical comorbidities, outpatient status was associated with a reduction in total facility costs of $972 (95% confidence interval $883-$1060, P < .001) compared to inpatient TKA. ConclusionOutpatient TKA costs hospitals nearly $1000 per patient less than inpatient TKA, yet the average difference in Medicare reimbursement for an outpatient procedure is $3157 less per patient. Centers for Medicare and Medicaid Services should reconsider the Outpatient Prospective Payment System classification of TKA to better incentivize surgeons to perform TKA as a lower cost outpatient procedure when safe and appropriate.

Response to: Casper, DS, et al. 2019. Medicaid reimbursement for common spine procedures: Are compensation rates consistent? Spine Volume 44, Number 22, pages 1585-1590: Deyo, RA. 2019. Point of view commentary "Medicaid reimbursement for common spine procedures: Are compensation rates consistent?" Spine Volume 44, Number 22, pages 1591-1592.

Alpine Orthopaedic and Spine, PC, Spokane, Washington [email protected] The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. Relevant financial activities outside the submitted work: grants.

Cost Analysis of Dual-Mobility Constructs in Revision Total Hip Arthroplasty: A European Payer Perspective.

Dual-mobility constructs have been shown to significantly and substantially decrease dislocations after revision total hip arthroplasty (THA). The authors have previously shown that dual-mobility (DM) constructs are cost-effective given their ability to decrease dislocations and re-revision for dislocation. The goal was to report the costs of DM and large femoral head (LFH) constructs in revision THAs from a European health care payer perspective. A Markov model was constructed to analyze the costs incurred by payers in the United Kingdom, Germany, Italy, and Spain over 3 years in revision THAs with DM or LFH constructs. Model states and probabilities were derived from prospectively collected registry data in 302 patients who underwent revision THA with a DM or 40-mm LFH construct and were then mapped to corresponding procedural reimbursement codes and tariffs for each country. Costs were weighted average national payments for reintervention procedures performed in the 3 years following revision THA. Probabilistic sensitivity analysis examined the effect of combined uncertainty across all model parameters. During a 3-year period following revision THA, reintervention rates were 9% for DM constructs and 19% for LFH constructs (P=.01). Comparing DM and LFH constructs, cumulative incremental costs over 3-years' follow-up were £428 vs £1447 in the United Kingdom, euro 451 vs euro 1272 in Germany, euro 540 vs euro 1425 in Italy, and euro 523 vs euro 1562 in Spain, respectively. At mid-term follow-up, DM constructs used in revision THAs were associated with a significantly lower risk of reintervention, which translated to lower health care payer costs compared with LFH constructs among European health care payers. [Orthopedics. 2020;43(4):250-255.].

Procedure Reimbursement, Inflation, and the Declining Buying Power of the Vascular Surgeon (2011-2019)

The purpose of this study was to evaluate the trend in Medicare reimbursement for common vascular procedures during the last decade. To enrich the context of this analysis, vascular procedure reimbursement is directly compared with inflation-adjusted changes in other surgical specialties.

Recent trends in medicare utilization and reimbursement for lumbar spine fusion and discectomy procedures

Background ContextUnderstanding the scope of the volume and costs of lumbar fusions and discectomy procedures, as well as identifying significant trends within the Medicare system, may be beneficial in enhancing cost-efficiency and care delivery. However, there is a paucity of studies which analyze recent trends in lumbar fusion volume, utilization, and reimbursements. PurposeThis study seeks to define the costs of lumbar fusions and discectomy procedures and identify trends and variations in volume, utilization, and surgeon and hospital reimbursement rates in the Medicare system between 2012 and 2017. Study DesignRetrospective database study. Patient SampleMedicare Part A and Part B claims submitted for lumbar spine procedures from 2012 to 2017, as documented in the Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use Files. Outcome MeasuresProcedure numbers and payments per episode. MethodsThis cross-sectional study tracked annual Medicare claims and payments to spine surgeons using publicly-available databases and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates (per 10,000 Medicare beneficiaries), and reimbursement rates, and to examine associations between county-specific and lumbar spine procedure utilization and reimbursements. ResultsA total of 772,532 lumbar spine procedures were performed in the Medicare population from 2012 to 2017, including 634,335 lumbar fusion surgeries and 138,197 primary lumbar discectomy and microdiscectomy single-level surgeries. There was a 26.0% increase in annual lumbar fusion procedure volume during the study period, with a compound annual growth rate (CAGR) of 4.7%. Lumbar discectomy/microdiscectomy experienced a 23.5% decrease in annual procedure volume (CAGR, −5.2%). Mean Medicare surgeon reimbursements for lumbar fusions nominally decreased by 3.7% from $767 in 2012 to $738 in 2017, equivalent to an inflation-adjusted decrease of 11.4% (CAGR, −0.7%). Mean Medicare payments for lumbar discectomy and microdiscectomy procedures nominally increased by 16.3% from $517 in 2012 to $601 in 2017, equivalent to an inflation-adjusted increase of 6.9% (CAGR, 3.1%). ConclusionsThis present study found the volume and utilization of lumbar fusions have increased since 2012, while lumbar discectomy and microdiscectomy volume and utilization have fallen. Medicare payments to hospitals and surgeons for lumbar fusions have either declined or not kept pace with inflation, and reimbursements for lumbar discectomy and microdiscectomy to hospitals have risen at a disproportionate rate compared to surgeon payments. These trends in Medicare payments, especially seen in decreasing allocation of reimbursements for surgeons, may be the effect of value-based cost reduction measures, especially for high-cost orthopedic and spine surgeries.