Reimbursement Trends Research Articles

Trends in Medicare physician reimbursement and utilization for proximal humerus fixation and shoulder arthroplasty

BackgroundFixation and arthroplasty remain the mainstays of surgical treatment of degenerative and traumatic shoulder pathology. They also constitute an appreciable sum of Medicare expenditure. With continued concern for declines in Medicare reimbursement across orthopedic surgery, it is important to understand how trends in reimbursement correlate with relative procedure volumes. Our aims were to describe temporal changes in procedure volumes, physician payment, and patient charges for proximal humerus open reduction internal fixation (ORIF) and shoulder arthroplasty. MethodsUsing Medicare's Physician Fee Schedules from 2012 to 2017, we examined procedure volumes, number of unique surgeons performing, actual submitted patient charges, and surgeon payments from 2012 to 2017 for six shoulder procedures: proximal humerus ORIF (CPT-23615), traumatic hemiarthroplasty (HEMI) (CPT-23616), degenerative HEMI (CPT-23470), primary total shoulder arthroplasty (TSA) (CPT-23472), partial TSA revision (humeral or glenoid component, CPT-23473), and total TSA revision (CPT-23474). The reimbursement ratio was calculated by dividing surgeon payment by patient charges. Growth rates of charges and payment were adjusted for inflation using annual consumer price index inflation rates over the same time period. ResultsThe total number of traumatic and degenerative HEMI cases fell over −60%. Similarly, the number of unique surgeons performing traumatic and degenerative HEMI fell over −53%. In contrast, the number of TSA procedures rose by +70%, whereas partial and total revision TSA rose by +62% and +88%, respectively. The number of unique surgeons rose +28% and over +73% for primary and revision TSA, respectively. There was a large gap (between 3.4 and 4.4 times) between submitted charges and surgeon payment for all years analyzed. After adjusting for inflation, Medicare payment to surgeons decreased for all types of surgery (−6% to −9%) other than ORIF, which increased +10%. Submitted patient charges during this period increased +14% and +9.7% for ORIF and revision TSA (total), respectively, but decreased by −6% for traumatic HEMI. The reimbursement ratio was ≤29% for all procedures analyzed across all years and fell the most for revision TSA (partial and total). ConclusionFrom 2012 to 2017, there was a sharp decline in the use of shoulder HEMI with a correspondingly high increase in TSA. After accounting for inflation, HEMI and TSA showed appreciable declines in surgeon payment over time, whereas ORIF was the only surgery with increased surgeon payment. Revision TSA saw the largest declines in the reimbursement rate. Physicians and health care policy makers must be aware of these trends to ensure both a sustainable payment infrastructure for surgeons as well as to maintain access to care for these procedures. Level of evidenceLevel III; Economic Study

Trends in Medicare Reimbursement for the Top 20 Surgical Procedures in Craniofacial Trauma

PURPOSE: Research regarding financial trends in craniofacial trauma surgery is limited. Understanding these trends is important to the evolvement of suitable reimbursement models in craniofacial plastic surgery. The purpose of this study was to evaluate the trends in Medicare reimbursement rates for the top 20 most commonly utilized surgical procedures for facial trauma from 2000 to 2021. METHODS: The 20 most commonly utilized Current Procedural Terminology codes for facial trauma repairs from 2000 to 2021 were queried from The National Summary Data File from the Centers for Medicare & Medicaid Services. Reimbursement data for each procedure were then extracted from The Physician Fee Schedule Lookup Tool. Changes to the United States consumer price index were used to adjust all gathered data for inflation to 2021 US dollars. The average annual and the total percent change in reimbursement were calculated for the included procedures based on the adjusted trends. RESULTS: From 2000 to 2021, the average reimbursement for all procedures decreased by 16.6% after adjusting for inflation. Closed treatment of TMJ dislocation and closed treatment of nasal bone fractures without manipulation demonstrated the greatest decrease in mean adjusted reimbursement at −48.7% and −48.3%, respectively, whereas closed treatment of nasal bone fractures without stabilization demonstrated the smallest mean decrease at −1.4% during the study period. Open treatment of nasal septal fractures with or without stabilization demonstrated the greatest increase in mean adjusted reimbursement at 18.9%, while closed treatment of nasal septal fractures with or without stabilization demonstrated the smallest increase at 1.2%. The average reimbursement for all closed procedures in the top 20 decreased by 19.3%, while that for all open procedures decreased by 15.5%. The adjusted reimbursement rate for all top 20 procedures decreased by an average of 0.8% each year. CONCLUSIONS: To the best of our knowledge, this is the first study to comprehensively evaluate trends in Medicare reimbursement for facial trauma surgical repairs. Adjusting for inflation, Medicare reimbursement for the top 20 most commonly utilized procedures has largely decreased from 2000 to 2021. Consideration of these trends by surgeons, hospital systems, and policymakers will be important to assure continued access to meaningful surgical facial trauma care in the United States.

A 20-year Analysis of Medicare Reimbursement for Abdominal Wall Reconstruction (2000–2020)

PURPOSE: Lack of financial data regarding procedural reimbursement trends in abdominal wall reconstruction was identified. Analysis of such trends is important to understand the sustainability of current reimbursement models and to ensure adequate reimbursement for reconstructive surgeries moving forward. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for 30 abdominal wall reconstruction surgical procedures over a 20-year period (2000–2020). METHODS: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was utilized for each of the 30 included current Procedural Terminology (CPT) codes, and reimbursement data were extracted. The list of CPT codes was compiled prior to data collection in order to ensure a representative and comprehensive analysis of commonly utilized procedural codes. Monetary data were adjusted for inflation to 2020 US dollars utilizing changes to the United States consumer price index. The R-squared, average annual percent change and average total percentage change in reimbursement were calculated based on these adjusted trends for all included procedures. RESULTS: After adjusting for inflation, the average reimbursement for all procedures decreased by 17.8% from 2000 to 2020. The greatest mean decrease was observed for CPT code 49568 (the implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection, −34.4%). The only procedure with an increased adjusted reimbursement rate throughout the study period was CPT code 20680 (+3.9%). From 2000 to 2020, the adjusted reimbursement rate for all included procedures decreased by an average of 0.88% each year, with an average R2 value of 0.80, indicating a stable decline throughout the study period. CONCLUSIONS: After adjusting for inflation, there has been a steady decline in Medicare reimbursement for the included procedures from 2000 to 2020. Increased awareness of these trends by surgeons, hospitals, and policy makers is necessary to assure continued access to optimal abdominal reconstruction care in the United States.

Decreasing Medicare Utilization, Reimbursement, and Reimbursement-to-Charge Ratio of Reconstructive Plastic Surgery Procedures: 2010 to 2019.

This study aimed to evaluate recent trends in utilization, reimbursement, and charges for reconstructive plastic surgery procedures billed to Medicare. We queried the Physician/Supplier Procedure Summary from the Centers for Medicare and Medicaid Services for procedures billed by plastic surgeons to Medicare Part B between 2010 and 2019. We collected service counts, charges, and reimbursements. We adjusted utilization by Medicare enrollment and adjusted monetary values for inflation. We calculated the weighted mean charge and reimbursement, which were used to calculate the reimbursement-to-charge ratio (RCR). We examined trends over time by calculating differences and performing correlation analyses of utilization, charges, reimbursement, and RCR for all procedures and for different procedural categories. From 2010 to 2019, the overall enrollment-adjusted utilization for 912 reconstructive procedures decreased by 6.6% (r2 = 0.46). Utilization increased in certain procedural categories such as skin debridement (+36.9%, r2 = 0.48) and procedures of the breast (+114.9%, r2 = 0.48). Charges increased by 32.9% (r2 = 0.99), reimbursement decreased by 5.3% (r2 = 0.84), and RCR decreased by 28.7% (r2 = 0.99). Skin replacement/flaps/grafts procedures underwent the greatest relative decrease in reimbursement (-26.8%, r2 = 0.87). Reimbursement-to-charge ratio decreased for all procedural categories except for procedures of the auditory system. In the past decade, Medicare utilization and reimbursement for reconstructive plastic surgery procedures decreased, whereas charges increased. This resulted in decreasing reimbursement relative to charged amounts. These findings raise concerns regarding the economic viability of providing plastic surgery services to an aging population and may impact patients' ability to access affordable plastic surgical care.

26307 Trends and factors associated with dermatology Medicare charges to payment ratios, 2012-2017

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 = .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.

Comparison of radical hysterectomy with pelvic lymphadenectomy and radical prostatectomy with lymphadenectomy: Medicare reimbursement 2010-2019

<h3>Objectives:</h3> To investigate differences in Medicare reimbursement between hysterectomy and prostatectomy (with lymphadenectomy) between Gynecology and Urology <h3>Methods:</h3> The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid was utilized to extract reimbursement data for the two CPT codes representing open radical hysterectomy with lymphadenectomy and laparoscopic radical hysterectomy with lymphadenectomy. Likewise, the CPT code representing open radical prostatectomy with lymphadenectomy and the two CPT codes representing laparoscopic radical prostatectomy and lymphadenectomy was also collected. There is no code that combines laparoscopic prostatectomy and lymphadenectomy, so the values were combined. Average annual and total percent change in reimbursement was calculated for each hysterectomy with lymphadenectomy and prostatectomy with lymphadenectomy. <h3>Results:</h3> Reimbursement for the open hysterectomy with lymphadenectomy decreased by an average of 13.72%, and for the open prostatectomy with lymphadenectomy by 27.88% from 2010 to 2019 with R-squared values of 0.98 and 0.92, respectively. Reimbursement rates from 2010 to 2019 for open procedures averaged $1,828.59 and $1,649.44, respectively. Reimbursement for laparoscopic hysterectomy with lymphadenectomy decreased by an average of 13.72% with an R-value of 0.98 and by 34.99% with an R-value of 0.94 for the laparoscopic prostatectomy with lymphadenectomy procedure. Reimbursement rates for laparoscopic procedures from 2010 to 2019 averaged $1,860.22 and $2,722.99, respectively. <h3>Conclusions:</h3> This study provides an analysis of trends in procedural Medicare reimbursement for oncologic procedures performed by gynecologic and urologic surgeons. Findings suggest that urologists are reimbursed slightly less for open radical prostatectomy with lymphadenectomy compared to their gynecology counterparts, while being reimbursed more for laparoscopic prostatectomy with lymphadenectomy compared to their gynecology counterparts. This is an area of concern since minimally invasive procedures have become the industry standard. Results suggest continuing disparities surrounding Medicare reimbursements for sex-specific procedures

Revision ACL reconstruction has higher incidence of 30-day hospital readmission, reoperation, and surgical complications relative to primary procedures.

Although there has been substantial improvement in ACL reconstructive surgery, graft failure remains a devastating complication for some patients. Revision procedures are inherently more complex and technically challenging. The purpose of this study is to determine the incidence of short-term complications after these procedures and to compare trends in operative length, relative valuation, and reimbursement after primary versus revision ACL reconstruction. Primary and revision arthroscopic ACL reconstruction cases were identified on the American College of Surgeons' NSQIP database using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes between January 1, 2012 and December 31, 2017. Demographics, patient variables, and surgical variables were compared between primary and revision groups using Chi-squared tests. Logistic regression was used to identify independent risk factors for revision ACL reconstruction. Various 30-day outcome measures were compared between the primary and revision ACL reconstruction groups. Various measures of valuation-including total relative value units (RVU) and reimbursement per minute-were calculated and compared between the two groups. A total of 8292 patients-8135 primary and 157 revision procedures-were included in the final cohort. Higher ASA scores were associated with revision ACL reconstructions. Patients undergoing revision procedures were less likely to have an ASA score of 1 (p < 0.001) and more likely to have an ASA score of 2 (p = 0.004) or 3 (p = 0.020). Revision ACL reconstruction was associated with higher rates of poor 30-day outcome measures, including unplanned readmission (p = 0.029), reoperation (p = 0.012), return to the OR (p = 0.012), and surgical complications (p = 0.021). The total RVUs and reimbursement for revision procedures were significantly greater than those for primary procedures (p < 0.001). However, when accounting for operative time, the RVU/minute and reimbursement/minute were similar between the two groups (n.s.). Relative to primary ACL reconstruction, revision ACL procedures are associated with worse short-term outcomes-including unplanned readmission, reoperation, return to the OR, and surgical complications. A greater ASA score was independently predictive of revision ACL surgery. The current RVU system undervalues revision ACL procedures, considering the increased operative time and complexity of such procedures. Level III.

Trends in coverage and reimbursement for reproductive genetic counseling in New Jersey by multiple payers from 2010 to 2018

Lack of consistent insurance coverage for genetic counseling services billed under Current Procedural Terminology (CPT) code 96040 creates a barrier for access to this service. This retrospective study examined coverage and reimbursement for reproductive genetic counseling encounters billed under CPT code 96040 as a professional fee over an eight-year period at Rutgers Robert Wood Johnson Medical School, a regional perinatal center in New Jersey, a state requiring licensure. Descriptive statistics were tabulated to assess the disparity between Medicare/Medicaid, Managed Care Medicaid, and commercial insurance payers, including how often encounters were covered and if reimbursed, at what percentage of the amount billed. A comparison of individual plan types (Health Maintenance Organization, Point of Service, and Preferred Provider Organization) was carried out. Overall trends in reimbursement were assessed across payers. The study found 61% of 60-min encounters billed to Medicare/Medicaid, Managed Care Medicaid, and commercial insurance payers received coverage. Of all covered 60-min encounters billed to Managed Care Medicaid and commercial insurance payers, an average of 36% of the amount billed was reimbursed. Medicare/Medicaid encounters were never reimbursed. Commercial insurance covered 65% of encounters billed but this varied between payers. Across all payers, an overall downward trend of reimbursement was demonstrated over the eight-year period. Lack of consistent service coverage creates a barrier and patients cannot universally access genetic counseling services. Steps to improve coverage need to include passing of legislation, notably the next bill to replace the former H.R. 3235, 'Access to Genetic Counselor Services Act of 2019' and provisions within third-party payers that allow for credentialing of genetic counseling providers.

Temporal and Geographic Trends in Medicare Reimbursement of Primary and Revision Shoulder Arthroplasty: 2000 to 2020.

A comprehensive understanding of the trends for financial reimbursement of shoulder arthroplasty is important as progress is made toward achieving sustainable payment models in orthopaedics. This study analyzes Medicare reimbursement trends for shoulder arthroplasty. We hypothesize that Medicare reimbursement has decreased for shoulder arthroplasty procedures from 2000 to 2020 and that revision procedures have experienced greater decreases in reimbursement. The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for each Current Procedural Terminology code used in shoulder arthroplasty, and physician reimbursement data were extracted. All monetary data were adjusted for inflation to 2020 US dollars. Both the average annual and the total percentage change in surgeon reimbursement were calculated based on these adjusted trends for all included procedures. Mean percentage change in adjusted reimbursement among primary procedures in comparison to revision procedures was calculated. The mean reimbursement was assessed and visually represented by geographic state. The average reimbursement for all shoulder arthroplasty procedures decreased by 35.5% from 2000 to 2020. Revision total shoulder arthroplasty (TSA) experienced the greatest mean decrease (-44.6%), whereas primary TSA (-23.9%) experienced the smallest mean decrease. The adjusted reimbursement rate for all included procedures decreased by an average of 1.8% each year. The mean reimbursement for revision procedures decreased more than the mean reimbursement for primary procedures (-41.1% for revision, -29.9% for primary; P < 0.001). The mean reimbursement for TSA in 2020, and the percent change in reimbursement from 2000 to 2020, varied by state. Medicare reimbursement for shoulder arthroplasty procedures has decreased from 2000 to 2020, with revision procedures experiencing the greatest decrease. Increased awareness and consideration of these trends will be important as healthcare reform evolves, and reimbursements for large joint arthroplasty are routinely adjusted.

Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined.

Background:Charge and reimbursement trends for arthroscopic partial meniscectomies among orthopaedic surgeons, anesthesiologists, and hospital/surgery centers have not been formally analyzed, even though meniscectomies are the most commonly performed orthopaedic surgery.Purpose:To analyze Medicare charge and reimbursement trends for surgeons, anesthesiologists, and hospital/surgery centers for outpatient arthroscopic partial meniscectomies performed in the United States.Study Design:Economic and decision analysis; Level of evidence, 4.Methods:We analyzed trends in surgeon, anesthesiologist, and hospital charges and reimbursements for outpatient isolated arthroscopic partial meniscectomies from 2005 to 2014. Current Procedural Terminology codes were used to capture charge and reimbursement information using the nationally representative 5% Medicare sample. National and regional trends for charge, reimbursement, and Charlson Comorbidity Index (CCI) were evaluated using linear regression analysis.Results:A total of 31,717 patients were analyzed in this study. Charges across all groups increased significantly (P < .001) during the 10-year study period, with an increase of 18.4% ($2754-$3262) for surgeons, 85.5% ($802-$1480) for anesthesiologists, and 116.8% ($2743-$5947) for hospitals. Surgeon reimbursements declined by 15.5% ($504-$426; P = .072) during this period. Anesthesiologist and hospital reimbursements increased significantly during by 36.5% ($133-$182; P < .001) and 28.9% ($1540-$1984; P < .001) during the 10-year study period, respectively. The annual incidence of partial meniscectomies per 10,000 database patients decreased significantly from 18.3 to 15.6 over the course of the study (14.8% decrease; P = .009), while the CCI did not change significantly (P = .798).Conclusion:Hospital and anesthesiologist Medicare reimbursements for outpatient arthroscopic partial meniscectomies increased significantly, while surgeon reimbursements decreased. In 2005, hospitals were reimbursed 205% more ($1540 vs $504) than surgeons, and by 2014, they were reimbursed 365% more ($1984 vs $426), indicating that the gap between hospital and surgeon reimbursement is rising. Improved understanding of charge and reimbursement trends represents an opportunity for key stakeholders to improve financial alignment across the field of orthopaedics.

PNS51 Global Survey of Genetic Testing Reimbursement Policies

Genetic testing is critical to optimizing the outcomes of targeted therapies since testing identifies patients who are most likely to benefit from these treatments. Further, product labels may require genetic testing. Thus, it is important to understand current genetic testing reimbursement policies. This study characterized the global reimbursement landscape of genetic testing across thirteen markets. Secondary research through various sources (e.g., insurance policies, fee schedules, laboratory catalogues, government websites, etc.) was conducted to understand current reimbursement mechanisms for genetic testing. Thirteen markets across five continents were surveyed: US, Canada, EU4, UK, Switzerland, Sweden, Japan, China, Brazil, and Australia. Findings on current reimbursement policies and coding infrastructure were synthesized. The presence of manufacturer-sponsored genetic testing was also researched. Several trends in genetic testing reimbursement were identified. While genetic testing is often reimbursed in the majority (10/13, 77%) of surveyed markets, 3/13 (23%) do not provide routine public reimbursement for genetic testing (Australia, Brazil, and China). The coding infrastructure utilized for genetic testing reimbursement varies across the 10/13 (77%) markets with coverage. 6/13 (46%) of markets (USA, France, Germany, Switzerland, Sweden, and Japan) often utilize general genetic testing codes, which are independent of any gene or disease. Codes specific to genes or diseases were found in 3/13 (23%) of markets (UK, Spain, and Canada). In 1/13 (8%) markets (Italy), both general and specific codes were identified. Manufacturer-sponsored genetic testing programs were identified in all markets across various diseases. These programs encompassed both direct patient sponsorship and more indirect avenues such as grants to research or patient advocacy organizations. Reimbursement of genetic testing varies globally across markets. Since securing reimbursement can be a complex process which differs across markets, sponsors should carefully assess any reimbursement barriers and consider mitigation tactics in order to increase access and uptake for products that require genetic testing.

The Near-Term Ramifications of Long-Term Trends in Orthopedic Surgical Reimbursement

BackgroundThere has been 25-year trend of decreasing value for orthopedic surgical work based on the Resource-Based Relative Value Scale (RBRVS) for Medicare reimbursement. This study was undertaken to estimate the time that Medicare payment rates for time spent in the office doing cognitive work will equal time dedicated in the operating room to performing procedural work based on long-term negative payment trends. MethodsThe RBRVS Update Committee database was accessed to extract the time elements for 2 procedures, total knee arthroplasty and total hip arthroplasty (27447 and 27130), on the day of surgery. The evaluation and management code mix for 2 mid-sized orthopedic practice was averaged to create an amalgamated rate for the reimbursement of office work on an hourly rate. A graph of the 25-year trend line in Medicare reimbursement for arthroplasty procedures was used to create a trend line. The trend line was then extrapolated to estimate the time in the future that the hourly rate for office work would equal the hourly rate for surgery. ResultsTime inputs and the Medicare conversion factor for 2021 were used in this analysis. Total procedural time for both 27447 and 27130 was 204 minutes (3.4 hours) on the day of surgery. An amalgamated hourly office rate of 7.9 relative value unit was calculated from the average of the 2 mid-sized private practices for an overall in office Medicare reimbursement of $318.89/h, with $1083.04 for the 3.4 hours allowed in the RBRVS Update Committee database for a joint replacement. When the trend line for reimbursement was extrapolated to the $1083.04 price point, the year corresponding to the point where hourly office reimbursement would equal hourly surgical work was 2024. ConclusionPolicymakers in Washington and practicing orthopedic surgeons need to consider the looming economic parity of surgical and cognitive work for Medicare. Continued negative reimbursement rates are likely to decrease patient access to necessary surgical care and result in de facto rationing of arthroplasty services for Medicare patients. The deployment of the orthopedic workforce is likely to change to accommodate the decreases in the value of surgical work. This trend will have significant impact on the practice of musculoskeletal medicine and patient access to orthopedic services.

Trends in volume and reimbursement of trainee-assisted services in dermatology: A retrospective analysis of Medicare 2010-2018 claims data

Trends in volume and reimbursement of trainee-assisted services in dermatology: A retrospective analysis of Medicare 2010-2018 claims data

Abstract No. 220 Percutaneous and surgical ablation versus partial nephrectomy for renal cell carcinoma: Medicare volume and physician payment trends from 2010 to 2018

A growing body of evidence demonstrates comparable outcomes for percutaneous ablation and partial nephrectomy for the treatment of renal tumors, along with lower morbidity and decreased cost for the former. The purpose of this study is to analyze trends in Medicare volume and physician reimbursement for these procedures from 2010 to 2018 and compare physician payments. Claims from the Medicare Part B Physician/Supplier Procedure Summary for the years 2010 to 2018 were extracted using the CPT codes for percutaneous and laparoscopic ablations and surgical and laparoscopic partial nephrectomy of renal tumors. Total volumes, physician payment, and trends were analyzed by procedure. From 2010 to 2018, overall 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%). There was also a 72.7% decrease in surgical ablations from 1260 to 344 procedures over this time period. In 2018, average physician payment for percutaneous ablation was $351.28, compared to $687.80 for surgical ablation, $802.67 for open partial nephrectomy, and $925.21 for laparoscopic partial nephrectomy. There has been a trend toward more minimally invasive techniques for treatment of renal cell carcinoma among Medicare patients. In the setting of a growing body of evidence showing comparable outcomes with surgery for smaller tumors, the volume of percutaneous ablation (particularly cryoablation) has increased by 80% from 2010 to 2018. There is also a strong physician payment cost advantage for this treatment over all surgical techniques.

Abstract No. 196 Percutaneous ablation of lung tumors has failed to gain traction: Medicare volume and physician reimbursement trends from 2012 to 2018

To analyze trends in Medicare volume and physician reimbursement for percutaneous lung ablation versus resection from 2012 to 2018 Claims from the Medicare Part B PSPSMF for the years 2012 to 2018 were extracted using the CPT codes for percutaneous ablation of lung tumors as well as video-assisted thoracoscopic (VATS) and open wedge resection and segmentectomy. Total volumes and physician payments were analyzed. Unexpectedly, from 2012 to 2018, overall volume of percutaneous ablation decreased from 652 to 518 procedures (-20.6%). In 2018, 317 were coded as radiofrequency ablation (RFA) and 201 as cryoablation. A large majority were performed by radiology (92.2% in 2012 and 96.3% in 2018) with only a small minority performed by thoracic surgery. Volume of wedge resection and segmentectomy also decreased from 16,488 to 14,619 procedures (-11.3%). Specifically, the volume of open resection decreased from 6,249 to 3,183 (-49.1%), while the volume of VATS resection increased from 10,239 to 11,436 (11.7%). In 2018, average physician reimbursement was $372.28 and $417.38 for percutaneous RFA and cryoablation, respectively. Reimbursement was $573.14 for open resection and $626.75 for VATS. Despite a growing body of evidence in favor of percutaneous ablation of lower stage lung tumors, its use in Medicare patients has declined from 2012 to 2018. This minimally invasive procedure is particularly important in this population that includes older patients with more comorbidities. The findings of this study suggest that evidence-based medicine has not impacted entrenched practice patterns in treatment of lower stage lung tumors.

Abstract No. 498 Trends in utilization and Medicare reimbursement for TIPS and open surgical portal decompression

To analyze trends in the number of minimally invasive TIPS (transjugular intrahepatic portosystemic shunt) vs. open surgical procedures performed for portal decompression in the Medicare population between 2009 and 2018 as well as the reimbursement rates for these procedures. Using the CPT Professional 2019 guidebook, 6 portosystemic decompression codes were identified: 1 for TIPS and 5 for open procedures. Medicare payments as well as the number of reimbursed procedures (allowed services) were selected for each code from the Centers for Medicare and Medicaid Services Part B National Summary Data Files between 2009 and 2018. All payments were adjusted for inflation to their respective 2018 prices. Four of the five open surgical codes were excluded from our analysis as they were performed < 10 times/year and were accordingly censored on the database. The total number of allowed services as well as payments per procedure were analyzed over time using linear regression. They were then compared between procedure types using tests for equality of slopes. Finally, TIPS cases as a proportion of total portosystemic decompressions were analyzed longitudinally via a chi-square test for trend. Significance in all analyses was defined as a 2-sided test with P < 0.05. The number of allowed TIPS procedures increased at a rate of 38.6 procedures/year between 2009 and 2018 (r2 = 0.67) while open procedures decreased at a rate of 2.8 procedures/year (r2 = 0.30) (P = 0.047). The reimbursements for TIPS decreased at a rate of $8.58 per year (r2 = 0.44) while the reimbursements for open procedures increased at a rate of $39.91 per year (r2 = 0.25) (P = 0.01). The number of TIPS cases as a proportion of total portosystemic decompressions increased from 95.0% in 2009 to 98.6% in 2018 (P < 0.001). In the Medicare population between 2009 and 2018, the number of TIPS procedures performed per year showed a positive trend while the number of open surgical procedures for portosystemic decompression demonstrated a slight negative trend. Payments for TIPS decreased while payments for the same open surgical procedures increased. Overall, TIPS was used at an increasing proportion of total portal decompression procedures over this time period, suggesting an increase in its availability or preference by physicians.

Decreasing physician Medicare reimbursement for dermatology services

Decreasing physician Medicare reimbursement for dermatology services

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.

An Evaluation of Gynecologic Procedure Billing by Medicare

Objective: The goal of this research was to evaluate trends in gynecologic surgical reimbursement and to determine the factors affecting compensation. Materials and Methods: Procedure codes represe...

Recent Trends in Medicare Utilization and Reimbursement for Orthopaedic Procedures Performed at Ambulatory Surgery Centers.

As part of a market-driven response to the increasing costs of hospital-based surgical care, an increasing volume of orthopaedic procedures are being performed in ambulatory surgery centers (ASCs). The purpose of the present study was to identify recent trends in orthopaedic ASC procedure volume, utilization, and reimbursements in the Medicare system between 2012 and 2017. This cross-sectional, national study tracked annual Medicare claims and payments and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates, and reimbursement rates, and to identify demographic predictors of ASC utilization. A total of 1,914,905 orthopaedic procedures were performed at ASCs in the Medicare population between 2012 and 2017, with an 8.8% increase in annual procedure volume and a 10.5% increase in average reimbursements per case. ASC orthopaedic procedure utilization, including utilization across all subspecialties, is strongly associated with metropolitan areas compared with rural areas. In addition, orthopaedic procedure utilization, including for sports and hand procedures, was found to be significantly higher in wealthier counties (measured by average household income) and in counties located in the South. This study demonstrated increasing orthopaedic ASC procedure volume in recent years, driven by increases in hand procedure volume. Medicare reimbursements per case have steadily risen and outpaced the rate of inflation over the study period. However, as orthopaedic practice overhead continues to increase, other Medicare expenditures such as hospital payments and operational and implant costs also must be evaluated. These findings may provide a source of information that can be used by orthopaedic surgeons, policy makers, investors, and other stakeholders to make informed decisions regarding the costs and benefits of the use of ASCs for orthopaedic procedures.