Reimbursement Trends Research Articles

Recent Trends in Medicare Utilization and Reimbursement for Lumbar Fusion Procedures: 2000–2019

Lumbar fusions are commonly performed spinal procedures. Despite this, publicly available lumbar fusion procedural and monetary data are sparse. This study aimed to evaluate trends in utilization and reimbursement for Medicare patients from 2000-2019. Medicare National Summary Data Files were used. Data were collected for true physician reimbursements and procedural rates for posterolateral fusion, anterior lumbar interbody fusion, posterior lumbar interbody fusion (PLIF), and combined PLIF and posterolateral fusion from 2000-2019. Reimbursement was adjusted to inflation utilizing the 2019 Consumer Price Index. From 2000-2019, 1,266,942 lumbar fusion procedures were billed to Medicare Part B. Annual number of lumbar interbody fusion procedures increased by 57,740 procedures (+95%) from 61,017 in 2000 to 118,757 in 2019. This change in annual volume varied by procedure type, with posterolateral fusion increasing from 24,873 procedures in 2000 to 45,665 procedures in 2019 (+20,792, +83.59%), anterior lumbar interbody fusion increasing from 4227 in 2000 to 29,285 procedures in 2019 (+25,058, 592.81%), PLIF increasing from 5579 procedures in 2000 to 5628 procedures in 2019 (+49, +0.88%), and combined PLIF and posterolateral fusion increasing from 26,338 procedures in 2012 to 38,179 procedures in 2019 (+11,841, +44.96%). The mean inflation-adjusted reimbursement decreased for posterolateral fusion from $1662.96 to $1245.85 (-$417.11, -25.08%), anterior lumbar interbody fusion from $1159.45 to $750.33 (-$409.12, -35.29%), PLIF from $1225.02 to $1223.72 (-$1.3, -0.11%), and combined PLIF and posterolateral fusion from $1541.59 per procedure in 2012 to $1467.08 per procedure in 2019. Lumbar fusions have increased in the last 2 decades, although reimbursement for all procedures has decreased. Knowledge of these trends is important to ensure adequate resource allocation to surgeons as treating lumbar pathologies becomes more common among the aging Medicare population.

Trends in Distal Radius Fixation Reimbursement, Charge, and Utilization in the Medicare Population

Background Distal radius fractures (DRF) are the second most common fragility fracture experienced by the elderly, and surgical management constitutes an appreciable sum of Medicare expenditure for upper extremity surgery. Using Medicare data from 2012 to 2017, our primary aim was to describe temporal changes in surgical treatment, physician payment, and patient charges for DRF fixation.Methods We examined surgical volumes and retrospective patient charge (services billed by surgeon) and surgeon payment (professional fee) data from 2012 to 2017 for four DRF surgeries: closed reduction percutaneous pinning (CRPP), open reduction internal fixation (ORIF) of extra-articular fractures, ORIF of intra-articular (IA) (2-fragment) fractures, and ORIF of IA (> 3 fragments) fractures. The reimbursement ratio was defined and calculated as the ratio of charges to payment. Rates were adjusted for inflation using the annual consumer-price index.Results For these four surgeries from 2012 to 2017, total patient charges grew by 64% from $117 to 193 million, while surgeon payment grew by 42% from $30 to 42 million. CRPP cases fell by 47%, while ORIF increased by 17, 14, and 45% for extra-articular, IA (2-fragment), and IA (> 3 fragments) surgeries, respectively. After adjusting for inflation, payment to physicians increased by more than or equal to 16% for all procedures except for CRPP, which fell by 2%. Charges during this same period increased from 13 to 38%. Reimbursement ratios declined from −9.2% to −13% for each procedure.Conclusion From 2012 to 2017, while charges have outpaced surgeon payment, payment has outpaced inflation for all forms of distal radius ORIF, aside from CRPP. There has been a continued sharp decline of CRPP. Level of Evidence is III, economic.

In Reply to the Letter to the Editor Regarding “Workforce Trends in Spinal Surgery: Geographic Distribution and Primary Specialty Characteristics from 2012 to 2017”

Lumbar fusions are commonly performed spinal procedures. Despite this, publicly available lumbar fusion procedural and monetary data are sparse. This study aimed to evaluate trends in utilization and reimbursement for Medicare patients from 2000–2019.Medicare National Summary Data Files were used. Data were collected for true physician reimbursements and procedural rates for posterolateral fusion, anterior lumbar interbody fusion, posterior lumbar interbody fusion (PLIF), and combined PLIF and posterolateral fusion from 2000–2019. Reimbursement was adjusted to inflation utilizing the 2019 Consumer Price Index.From 2000–2019, 1,266,942 lumbar fusion procedures were billed to Medicare Part B. Annual number of lumbar interbody fusion procedures increased by 57,740 procedures (+95%) from 61,017 in 2000 to 118,757 in 2019. This change in annual volume varied by procedure type, with posterolateral fusion increasing from 24,873 procedures in 2000 to 45,665 procedures in 2019 (+20,792, +83.59%), anterior lumbar interbody fusion increasing from 4227 in 2000 to 29,285 procedures in 2019 (+25,058, 592.81%), PLIF increasing from 5579 procedures in 2000 to 5628 procedures in 2019 (+49, +0.88%), and combined PLIF and posterolateral fusion increasing from 26,338 procedures in 2012 to 38,179 procedures in 2019 (+11,841, +44.96%). The mean inflation-adjusted reimbursement decreased for posterolateral fusion from $1662.96 to $1245.85 (−$417.11, −25.08%), anterior lumbar interbody fusion from $1159.45 to $750.33 (−$409.12, −35.29%), PLIF from $1225.02 to $1223.72 (−$1.3, −0.11%), and combined PLIF and posterolateral fusion from $1541.59 per procedure in 2012 to $1467.08 per procedure in 2019.Lumbar fusions have increased in the last 2 decades, although reimbursement for all procedures has decreased. Knowledge of these trends is important to ensure adequate resource allocation to surgeons as treating lumbar pathologies becomes more common among the aging Medicare population.

Abstract No. 600 Cholecystitis treatment and reimbursement trends

Abstract No. 600 Cholecystitis treatment and reimbursement trends

20-year Inflation-Adjusted Medicare Reimbursements (Years: 2000-2020) For Common Lumbar and Cervical Degenerative Disc Disease Procedures.

Reimbursement trends for common procedures have persistently declined over the past 2 decades. Spinal instrumentational and fusion procedures are increasingly utilized and have increased in clinical complexity, yet longitudinal inflation-adjusted data for Medicare reimbursements of these procedures have not been evaluated. The Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool was used to extract Medicare reimbursements for the 5 most common spinal procedures and associated instrumentations from 2000-2020. Current Procedural Terminology (CPT) codes include 22551, 22600, 22633, 63030, and 63047 as well as instrumentation CPT codes 22840 and 22842-6. The nominal values were adjusted for inflation according to the latest consumer price index (U.S. Bureau of Labor Statistics; reported as 2020 USD) and used to calculate average annual percent changes and compound annual growth rates (CAGRs) in reimbursements. After inflation adjustment, the physician fee reimbursement decreased by 11.05% ± 8.46% (mean ± s.d., from $2,009.89 in 2011 to $1,787.85 in 2020) for anterior cervical discectomy and fusion (ACDF), 28.38% ± 8.42% (from $1,889.38 in 2000 to $1,353.14 in 2020) for posterior cervical fusion, 7.85% ± 8.20% (from $2,111.20 in 2012 to $1,945.49 in 2020) for transforaminal lumbar interbody fusion (TLIF), 28.17% ± 13.88% (from $1,421.78 in 2000 to $1,021.22 in 2020) for lower back disc surgery, and 31.88% ± 8.22% (from $1,700.38 in 2000 to $1,158.25 in 2020) for lumbar laminectomy. Instrumentation reimbursements showed an average decrease of 33.43% ± 8.4% over this period. Average CAGR was -1.7% ± .41% for procedures and -2.02% ± .14% for instrumentation. Our analysis reveals a persistent decline in reimbursement rates of the most common spine procedures and instrumentation since the year 2000. If unaddressed, this trend can serve as a substantial disincentive for physicians to perform these procedures and can significantly limit access to spinal care at the population level.

Growth in Thoracentesis and Paracentesis Performed by Radiology and Advanced Practice Providers: Medicare Volume and Reimbursement Trends From 2012 to 2018.

To study trends in volume and reimbursement for paracentesis and thoracentesis by physicians and advanced practice providers (APPs) after the introduction of discreet Current Procedural Terminology codes for image guidance. Medicare claims for 2012 to 2018 (paracentesis) and 2013 to 2018 (thoracentesis) were extracted using Current Procedural Terminology codes for blind and image-guided paracentesis and thoracentesis. Total volumes were analyzed by provider specialty. Nonfacility reimbursement and relative value units were compared. For blind paracentesis, volume decreased from 17,393 to 12,226 procedures from 2012 to 2018. Conversely, volume of image-guided paracentesis increased from 171,631 to 253,834 procedures. Radiology performed the majority of image-guide paracentesis (83.9% in 2012 and 77.1% in 2018). Volume and relative share for APPs dramatically increased (from 10.2% to 15.8%). For blind thoracentesis, volume decreased from 26,716 to 15,075 procedures from 2013 to 2018. Conversely, volume of image-guided thoracentesis increased from 187,168 to 222,673 procedures. Radiology performed the majority of image-guided thoracentesis (73.6% in 2013 and 66.2% in 2018). Volume and relative share for APPs dramatically increased (from 7.7% to 12.9%). Although reimbursement for both image-guided paracentesis and thoracentesis decreased, their reimbursement remained higher than that of blind paracentesis and thoracentesis throughout the study period. A higher percentage of these procedures are being performed using image guidance; radiologists performed a growing number but declining percentage of image-guided paracentesis and thoracentesis. APPs are playing an increasing role, particularly using image guidance. Given decreasing reimbursement for these procedures, APPs can provide a large cost advantage in procedural radiology practices.

C-29 | Trends in Utilization, Reimbursement, and Geography for TAVR performed by Cardiologists for the Medicare Beneficiaries: 2015-2019

C-29 | Trends in Utilization, Reimbursement, and Geography for TAVR performed by Cardiologists for the Medicare Beneficiaries: 2015-2019

Reductions in Reimbursement and Relative Value Units for Interventional Radiology Procedures: Trends from 2011 to 2021 Compared with Those for Other Physician Specialties

PurposeTo compare recent trends in Medicare reimbursement and relative value units (RVUs) for interventional radiology (IR) procedures similar to those performed by non-IR specialties. Materials and MethodsData from the Centers for Medicare and Medicaid Services Physician Fee Schedule for facility reimbursement and RVU component values for 23 commonly performed single Current Procedural Terminology IR procedures were compared with similar procedures or procedures for similar indications performed by non-IR specialties between 2011 and 2021. ResultsThe work RVU component decreased in 18 of 23 (78.3%) IR procedures compared with 6 of 23 (26.1%) similar procedures performed by non-IR specialties. The largest change in single RVU component was a 19.2% reduction in practice expense RVU for IR compared with a 16.5% reduction for similar procedures performed by non-IR specialties. ConclusionsAs a specialty, IR experienced a disproportionately greater reduction in reimbursement and RVU valuation for a range of comparable procedures performed by non-IR specialties.

Medicare reimbursement trends from 2000 to 2020 in head and neck surgical oncology.

BackgroundConsidering limited data exploring reimbursement trends at the subspecialty level within head and neck surgical oncology, we sought to characterize these trends for head and neck‐specific codes from 2000 to 2020.MethodsUsing the Centers for Medicare and Medicaid Services' Physician Fee Schedule Look‐Up Tool, reimbursement data, adjusted to 2020 U.S. dollars, for 37 head and neck surgical oncologic procedure codes were collected from 2000 to 2020.ResultsFrom 2000 to 2020, despite gross reimbursement for all head and neck procedures increasing by 23.2%, when adjusted for inflation, physician reimbursement decreased by 19.4%. Only 4 of 37 examined codes increased in net reimbursement over the study period.ConclusionMedicare reimbursement for the most common head and neck oncologic procedure codes decreased from 2000 to 2020. Further research is necessary to explore the implications of these trends on the delivery of patient care.

Increasing medicare charge-to-payment ratios for dermatologists from 2012 to 2017.

Government-backed medical insurance plans have undergone significant changes in the last decade, but more information is needed to understand reimbursement trends, particularly for specialist medical services. The objective of this study was to identify the ratios of submitted dermatology service charges to allowed Medicare payments over the years. Further variables studied include regional or state variations, gender of provider, hierarchical condition category (HCC) risk scores of patient complexity, and number of services. Data were collected from publicly available Medicare Part B Provider Utilization and Payment Data: Physician and Other Supplier 2012-2017 datasets. All data analysis was performed on SAS 9.4 Statistical Software.Total dermatology related medicare charges-to-payment ratios steadily increased over the years (1.77 [in 2012], 1.82 [2013], 1.87 [2014], 1.95 [2015], 2.02 [2016], and 2.06 [2017]). This suggests that for every $2.06 charged in 2017, dermatology providers could expect $1 of actual payment. When further stratified into medical services vs. drug services, this upward trend remained for medical charges but drug service ratios have remained constant. There was also significant geographic variation in total medicare charges-to-payment ratios as states in the Midwest (mean total ratio: 2.48) had higher charges to payment gaps than states in the Northeast (2.26), West (2.16), and South (1.99; p = 0.01).This study identifies trends and variables associated with dermatology medicare payments. Providers may use this information to better understand changing payment structures in their own practices and hopefully these results can be valuable in future policy discussions.

Reimbursement Trends in Pediatric Otolaryngology From 2000 to 2020: A CMS Physician Fee Schedule Analysis.

The aim of this study was to evaluate the financial trends in Medicare reimbursement rates for the most billed procedures at a single institution from 2000 to 2020 within pediatric otolaryngology. Retrospective data analysis. United States. The most billed surgical and in-office procedures in pediatric otolaryngology at our institution were identified in the Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services to extract reimbursement data for each CPT code (Current Procedural Terminology). Monetary data were adjusted for inflation to 2020 US dollars per the changes to the consumer price index. Mean annual and total percentage changes in reimbursement were calculated by the adjusted values for all included procedures (N = 25). From 2000 to 2020, without adjusting for inflation, reimbursement for the most billed procedures increased by 10.9%, while the allocated relative value unit per procedure increased by 15.4%. However, when adjusted for inflation, reimbursement for these procedures decreased by 27.5% over the study period. The study findings identify a downward trend in reimbursement for the most billed procedures in pediatric otolaryngology at our institution. Given the low predominance of pediatric otolaryngology codes within Medicare reimbursement, these codes are rarely reviewed for accurate revaluation. It is imperative that our professional society remain active and engaged within this process to ensure quality delivery of care to our patients.

The economics of moonshots: Value in rare disease drug development.

The economics of moonshots: Value in rare disease drug development.

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.

Declining Medicare Reimbursement for Diagnostic Radiology: A 10-Year Analysis Across 50 Imaging Studies

IntroductionThe aim of this study was to investigate trends in Medicare reimbursement from 2011 to 2021 for common diagnostic imaging studies, both at the individual study level and stratified by imaging modality. MethodsThe 50 most common imaging studies in diagnostic radiology were identified and the global reimbursement data from the Center of Medicare and Medicaid Services for each study was extracted from 2011 to 2021. The reimbursement rates were adjusted for inflation and assessed as a function of time for each individual study and by imaging modality. ResultsThere was a combined mean reduction of inflation adjusted payments of 44.4% across all included imaging studies from 2011 to 2021. Only 3 out of 50 studies saw an increase in adjusted reimbursement during this time. Linear regression analysis revealed that the total mean adjusted reimbursement overall has significantly declined over time (R2 = 0.78, P = 0.0003). The pooled adjusted yearly percent change was also investigated, and an increase in reimbursement was only seen from 2016 to 2017 (+ 0.2%). The period with the steepest decline was in 2013 to 2014 (-16%). The overall yearly percent change was -5.5%. Lastly, reimbursement was stratified by imaging modality. MRI (-60.6%), CT (-44.4%), ultrasound (-31.3%), and radiographs (-6.2%) all experienced a mean decline in reimbursement, though at significantly different severities (P <0.0001). An evaluation of wRVUs during the study period revealed a decline from a mean value of 0.79 to 0.78 wRVUs (-1.3%). ConclusionDiagnostic radiology has experienced significant reimbursement cuts over the past decade, most severely among cross sectional modalities. This data further characterizes reimbursement trends for the field and suggests the need for sustainable future reimbursement schedules.

Comparing economic outcomes and reimbursement trends between primary total knee arthroplasty and unicompartmental knee arthroplasty

Background Economic outcomes are of paramount importance in the American healthcare market as healthcare costs continue to rise. The Centers of Medicare and Medicaid Services (CMS) introduced the relative value unit (RVU) in 1992 to operationalize economic outcomes of healthcare interactions and procedures available to patients. The purpose of this study is to compare the RVU and dollar compensations, operative times, and compensation rates of unicompartmental knee arthroplasty (UKA) vs total knee arthroplasty (TKA) in the context of procedural and perioperative care requirements. Methods The National Surgical Quality Improvement Program database was used to query all UKAs and TKAs (current procedural terminology codes 27446 and 27447, respectively) performed between January 1, 2015 and December 31, 2017. 162,239 cases were analyzed: 157,107 TKAs and 5,132 UKAs. For all economic and medical variables, unpaired t-test and Pearson’s chi-squared test were used to compare continuous and categorical data, respectively. Results RVUs for UKAs and TKAs were 17.48 and 20.72, respectively. The mean operative time for UKAs was 83.80 ± 30.13 minutes and 89.43 ± 31.88 minutes for TKAs (p &lt; 0.001). The mean RVU/min for UKAs and TKAs were 0.23 ± 0.08 and 0.26 ± 0.09, respectively (p &lt; 0.001). Dollar reimbursements for UKA vs TKA were as follows: per minute ($8.46 vs $9.36) and per case ($630.85 vs $747.78). TKAs were associated with longer hospital length of stay (2.52 ± 3.20 vs. 1.43 ± 2.72 days; p &lt; 0.001), quicker onset of deep wound infection (18.46 ± 7.24 vs. 21.43 ± 5.19 days; p &lt; 0.001), and higher rates of 30-day unplanned hospital readmission (3.07% vs. 1.87%; p &lt; 0.001). Conclusion The study found the contemporary RVU reimbursement model adequately accounts for increased operative time and perioperative care demands associated with TKA compared to UKA, as RVU and dollar compensation rates per case and per minute were significantly greater for TKAs.

Declining trends in Medicare physician reimbursements for surgical procedures in orthopaedic oncology from 2002 to 2018: a retrospective review of payment data

Background: As the United States (US) healthcare system evolves towards cost-containment and value-based approaches, evaluating trends in procedure reimbursements will be critical for assessing and ensuring financial stability of highly specialized fields, such as orthopaedic oncology. Methods: The Medicare Physician Fee Schedule (MPFS) look-up tool was accessed through the official Center for Medicaid and Medicare Services website and used to retrieve average reimbursement rates for 28 common orthopaedic oncologic procedures (radical resections of soft tumors, bone tumors, and prophylactic treatment, nailing, or pinning) from 2002 to 2018. All reimbursement data were adjusted for inflation to 2018 dollars. For each Current Procedural Terminology (CPT) code, average reimbursement percentage change from 2002 to 2018 was calculated. Results: Based on the included codes, physician payment data for 28 surgical procedures from 2002 to 2018 were retrieved from the MPFS database. After adjusting all data for inflation, the average reimbursement for all included procedures decreased by 9.9% from 2002 to 2018, representing an estimated average decrease of 1.1% every couple of years. Reimbursement percentage decreases were the most significant prior to the Medicare Access and CHIP Reauthorization Act (MACRA), with reimbursements decreasing by an average of 5.8% from 2002 to 2014. However, reimbursement rates still declined by an average of 4.3% from 2014 to 2018 (after MACRA). Discussion: Reimbursements for orthopaedic oncologic procedures have steadily decreased over time. With orthopaedic oncology being a highly specialized field with few practicing providers, health policy makers need to understand the financial implications of the declining reimbursement rates to ensure financial stability and viability of the specialty. Level of Evidence: Level III.

Declining Trends in Medicare Reimbursement in Orthopaedic Foot and Ankle Surgery

Category:Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma; OtherIntroduction/Purpose:With the increasing complexity of physician reimbursement models, understanding reimbursement trends is crucial to the financial sustainability of orthopaedic practices nationwide. Inflation-adjusted Medicare physician reimbursement for total joint arthroplasty has decreased by approximately 33% from 2000 to 2019. Recent trends in orthopaedic foot and ankle reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2020 for common orthopaedic foot and ankle surgical procedures.Methods:The financial database of a single academic tertiary care center was queried to identify the CPT codes most frequently utilized in orthopaedic foot and ankle care. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the consumer price index and reported in 2020 US dollars (USD). Average annual and the total percent change in reimbursement were calculated for included procedures.Results:After adjusting for inflation, the average physician reimbursement decreased by 31.6% for all included foot and ankle procedures from 2000 to 2020, with 23/30 codes decreasing by more than 30%. The greatest decrease in reimbursement observed from 2000 to 2020 was for open treatment of calcaneal fracture at 48.3% ($2,254.17 to $1,164.97), followed by flexor tendon repair at 48.2% ($741.02 to $357.39), and open treatment of pilon fracture at 43.9% ($2,451.37 to $1,076.36).Conclusion:Over the past two decades, physician reimbursement for foot and ankle procedures has dramatically decreased by up to 48.3%. Continued downward trends in orthopaedic foot and ankle physician reimbursement may lead to decreased access to quality foot and ankle care.

Trends in Medicare Physician and Facility Fee Reimbursement in Orthopaedic Foot and Ankle

Category:Ankle; Ankle Arthritis; Arthroscopy; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; TraumaIntroduction/Purpose:The purpose of the study was to examine the trends in physician and facility reimbursement for the orthopaedic foot and ankle subspecialty utilizing the 23 most common foot and ankle surgeries based on national payment amounts.Methods:The Current Procedural Terminology (CPT) codes and corresponding Medicare Severity - Diagnosis Related Group (MS-DRG) codes for the 23 most common orthopaedic foot and ankle surgeries were identified. With the CPT codes, physician reimbursement was obtained through querying the Medicare Physician Fee Schedule (MPFS) for the work, malpractice, and practice expense relative value units (RVU) and then multiplying the total RVUs by the yearly conversion factor. CPT codes were also utilized to gather hospital outpatient reimbursement data from the Hospital Outpatient Prospective Payment System (OPPS) database. Hospital inpatient reimbursement rates were obtained from the Hospital Inpatient Prospective Payment System (IPPS) database utilizing the MS-DRG codes. All amounts were then adjusted for inflation using the Consumer Price Index (CPI).Results:From 2008 to 2021, physician reimbursement for the 23 most common orthopaedic foot and ankle surgeries decreased by 20%, with a mean Compound Annual Growth Rate (CAGR) of -1.7%. Hospital inpatient reimbursement increased by 34.7% with a mean CAGR of 2.3%; while outpatient hospital reimbursement increased by 97.2% with a mean CAGR of 5.1%.Conclusion:Over the past 13 years, physician reimbursement for common orthopaedic foot and ankle surgeries has declined while hospital reimbursement has increased. The larger increase in outpatient reimbursement compared to inpatient reimbursement highlights how CMS aims to transition surgeries from the inpatient setting to the more efficient and less expensive outpatient setting. This downward pressure on physician reimbursement while incentivizing outpatient services could have many unintended consequences on the landscape of foot and ankle practice in the US.

Trends in physician reimbursements and procedural volumes for radiosurgery versus open surgery in brain tumor care: an analysis of Medicare data from 2009 to 2018.

Given its minimally invasive nature and effectiveness, stereotactic radiosurgery (SRS) has become a mainstay for the multimodal treatment of intracranial neoplasm. However, no studies have evaluated recent trends in the use of SRS versus those of open resection for the management of brain tumor or trends in the involvement of neurosurgeons in SRS (which is primarily delivered by radiation oncologists). Here, the authors used publicly available Medicare data from 2009 to 2018 to elucidate trends in the treatment of intracranial neoplasm and to compare reimbursements between these approaches. By using CPT Professional 2019, the authors identified 10 open resection and 9 SRS codes (4 for neurosurgery and 5 for radiation oncology) for the treatment of intracranial neoplasm. Medicare payments (inflation adjusted) and allowed services (number of reimbursed procedures) for each code were abstracted from the Centers for Medicare and Medicaid Services Part B National Summary Data File (2009-2018). Payments per procedure and procedures per 100,000 Medicare enrollees were analyzed with linear regression and compared with tests for equality of slopes (α = 0.05). The average payment per procedure over the study period was compared by using the 2-tailed Welsh unequal variances t-test, and more granular comparisons were conducted by using ANOVA with post hoc Tukey honestly significant difference (HSD) tests. From 2009 to 2018, the number of SRS treatments per 100,000 Medicare enrollees for intracranial neoplasm increased by 3.97 cases/year (R2 = 0.99, p < 0.001), while comparable open resections decreased by 0.34 cases/year (R2 = 0.85, p < 0.001) (t16 = 7.5, p < 0.001). By 2018, 2.6 times more SRS treatments were performed per 100,000 enrollees than open resections (74.9 vs 28.7 procedures). However, neurosurgeon involvement in SRS treatment declined over the study period, from 23.4% to 11.5% of SRS treatments; simultaneously, the number of lesions treated per session increased from 1.46 to 1.84 (R2 = 0.98, p < 0.001). Overall, physician payments from 2013 to 2018 averaged $1816.08 (95% CI $1788.71-$1843.44) per SRS treatment and $1565.59 (95% CI $1535.83-$1595.34) per open resection (t10 = 15.9, p < 0.001). For neurosurgeons specifically, reimbursements averaged $1566 per open resection, but this decreased to $1031-$1198 per SRS session; comparatively, radiation oncologists were reimbursed even less (average $359-$898) per SRS session (p < 0.05 according to the Tukey HSD test for all comparisons). Over a decade, the number of open resections for intracranial neoplasm in Medicare enrollees declined slightly, while the number of SRS procedures increased greatly. This latter expansion is largely attributable to radiation oncologists; meanwhile, neurosurgeons have shifted their involvement in SRS toward sessions for the management of multiple lesions.

Percutaneous ablation of renal tumors versus surgical ablation and partial nephrectomy: Medicare trends and reimbursement cost comparison from 2010 to 2018.

The purpose of this study is to analyze trends in Medicare volume and reimbursement for percutaneous and surgical ablation as well as laparoscopic and open partial nephrectomy for treatment of small renal tumors from 2010 to 2018. Claims from the Medicare Part B Physician/Supplier Procedure Summary from 2010 to 2018 were extracted using CPT codes for percutaneous and surgical renal ablation and surgical and laparoscopic partial nephrectomy. Facility reimbursement and relative value units (RVUs) were obtained using the Centers for Medicare & Medicaid Services physician fee schedule look-up tool. Volume of percutaneous ablation increased from 2539 to 4571 procedures (80.0%). Specifically, percutaneous cryoablation became the dominant technique, increasing from 1434 to 2981 procedures (107.9%). Overall, volume of partial nephrectomy also increased by 40.4%, driven by an increase in laparoscopic partial nephrectomy from 3227 to 7770 procedures (140.8%) with a decrease in open partial nephrectomy from 3489 to 1661 (- 52.4%). Volume of surgical ablations also decreased 72.7% from 1260 to 344 procedures. In 2018, reimbursement was $358.56 for percutaneous radiofrequency ablation, $481.32 for percutaneous cryoablation, $1216.43 for surgical radiofrequency ablation, $1269.35 for surgical cryoablation, $1381.67 for open partial nephrectomy, and $1552.66 for laparoscopic partial nephrectomy. There has been a trend toward minimally invasive techniques for treatment of small renal tumors among Medicare patients. Laparoscopic partial nephrectomy has become the dominant treatment. In the setting of evidence showing comparable outcomes with surgery as well as lower costs to insurers, the volume of percutaneous ablation has also markedly increased.