Analysis of 20-Year Trends in Medicare Reimbursement for Reconstructive Microsurgery

2021 ◽  
Author(s):  
Nikita Gupta ◽  
Chad M. Teven ◽  
Jason W. Yu ◽  
Sami Abujbarah ◽  
Nathan A. Chow ◽  
...  
Keyword(s):  
Vein Graft ◽  
Medicare Reimbursement ◽  
Current Procedural Terminology ◽  
Microvascular Anastomosis ◽  
Reimbursement Rate ◽  
Financial Investment ◽  
Total Percentage ◽  
Reconstructive Microsurgery ◽  
Microsurgical Techniques ◽  
Fee Schedule

Abstract Background Microsurgery is being increasingly utilized across surgical specialties, including plastic surgery. Microsurgical techniques require greater time and financial investment compared with traditional methods. This study aimed to evaluate 20-year trends in Medicare reimbursement and utilization for commonly billed reconstructive microsurgery procedures from 2000 to 2019. Materials and Methods Microsurgical procedures commonly billed by plastic surgeons were identified. Reimbursement data were extracted from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services for each current procedural terminology (CPT) code. All monetary data were adjusted for inflation to 2019 U.S. dollars. The average annual and total percentage changes in reimbursement were calculated based on these adjusted trends. To assess utilization trends, CMS physician/supplier procedure summary files were queried for the number of procedures billed by plastic surgeons from 2010 to 2018. Results After adjusting for inflation, the average reimbursement for all procedures decreased by 26.92% from 2000 to 2019. The greatest mean decrease was observed in CPT 20969 free osteocutaneous flaps with microvascular anastomosis (−36.93%). The smallest mean decrease was observed in repair of blood vessels with vein graft (−9.28%). None of the included procedures saw an increase in reimbursement rate over the study period. From 2000 to 2019, the adjusted reimbursement rate for all procedures decreased by an average of 1.35% annually. Meanwhile, the number of services billed to Medicare by plastic surgeons across the included CPT codes increased by 42.17% from 2010 to 2018. Conclusion This is the first study evaluating 20-year trends in inflation-adjusted Medicare reimbursement and utilization in reconstructive microsurgery. Reimbursement for all included procedures decreased over 20% during the study period, while number of services increased. Increased consideration of these trends will be important for U.S. policymakers, hospitals, and surgeons to assure continued access and reconstructive options for patients.

P3814An analysis of Medicare reimbursement rates in cardiology from 2000 to 2018

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Bhatt ◽  
J Haglin ◽  
A S Tseng ◽  
K Mishark
Keyword(s):  
Price Index ◽  
Consumer Price Index ◽  
The United States ◽  
Medicare Reimbursement ◽  
Reimbursement Rate ◽  
Policy Makers ◽  
Total Percentage ◽  
Cardiology Department ◽  
Fee Schedule

Abstract Background There is a paucity of data regarding financial trends for procedural reimbursement in the field of cardiology. A comprehensive understanding of such trends is important as continued progress is made to advance agreeable reimbursement models in cardiology while maintaining quality of care. Purpose To evaluate monetary trends in Medicare reimbursement rates for 10 commonly utilized cardiology procedures from 2000 to 2018. Methods Reimbursement data was extracted using The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services of the 10 included Current Procedural Terminology (CPT) codes in cardiology. The utilized CPT codes included each of the top two most frequently billed codes in the echocardiology, catheterization, pacemaker, electrophysiology, and device integrations divisions of our local cardiology department during the 2017 calendar year. All monetary data for each code was adjusted for inflation to 2018 US dollars (USD) utilizing changes to the United States consumer price index (CPI). If the code was redefined throughout the study period, the correct replacement code was utilized for each year as defined by the procedure. The R-squared and both the average annual and the 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 38.2% from 2000 to 2018. The greatest mean decrease was observed in transthoracic echocardiogram (−64.4%). The only procedure with an increased adjusted reimbursement rate throughout the study period was biopsy of heart lining (+60.4%). From 2000 to 2018, the adjusted reimbursement rate for all included procedures decreased by an average of 2.8% each year, with an average R-squared value of 0.81, indicating a stable decline throughout the study period. Conclusion This is the first study to evaluate trends in procedural Medicare reimbursement for cardiology. When adjusted for inflation, Medicare reimbursement for included procedures has steadily decreased from 2000 to 2018. Increased awareness and consideration of these trends will be important for policy-makers, hospitals, and surgeons in order to assure continued access to meaningful cardiology care both at the local and global level.

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

Hand ◽  
2021 ◽  
pp. 155894472199080
Author(s):  
Danielle A Thornburg ◽  
Nikita Gupta ◽  
Nathan Chow ◽  
Jack Haglin ◽  
Shelley Noland
Keyword(s):  
Consumer Price Index ◽  
Hand Surgery ◽  
The United States ◽  
Medicare Reimbursement ◽  
Reimbursement Rate ◽  
Time Period ◽  
Long Term Trends ◽  
Fee Schedule ◽  
Procedure Codes ◽  
The Impact

Background: 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. Methods: 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. Results: 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). Conclusion: 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.

Abstract TMP75: Average Medicare Reimbursement for Stroke Care Has Decreased From 2000-2019

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Andrew R Pines ◽  
Jack Haglin ◽  
Bart Demaerschalk
Keyword(s):  
United States ◽  
Price Index ◽  
Hemorrhagic Stroke ◽  
Consumer Price Index ◽  
Stroke Care ◽  
The United States ◽  
Medicare Reimbursement ◽  
Reimbursement Rate ◽  
Icd Codes ◽  
The Difference

Introduction: There is a lack of data regarding financial trends for procedural reimbursement in stroke care. An understanding of such trends is important as progress is made to advance agreeable reimbursement models in the care of stroke patients. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for commonly utilized procedures in stroke care from 2000 to 2019. Methods: Reimbursement data for Current Procedural Terminology (CPT) codes was extracted from the Centers for Medicare & Medicaid Services. CPT codes were determined by frequency of procedures for Stroke-related ICD codes at our institution. All monetary data was adjusted for inflation to 2019 US dollars utilizing changes to the United States consumer price index. Results: After adjusting for inflation, the average reimbursement for all four included procedures within hemorrhagic stroke (ICD I60-I62) decreased by 18.4% from 2000 to 2019. The average reimbursement for two procedures within ischemic stroke (ICD I63), craniotomy and thrombectomy, increased by 3.5% (2003 -2019) and increased 3.0% (2016-2019), respectively. Data was not available for craniotomy prior to 2003, and not available for thrombectomy prior to 2016. Further, the adjusted reimbursement rate for included telestroke codes decreased by 12.1% from 2010-2019. All other included procedures decreased by 3.5% throughout this time. The difference in reimbursement rate between telestroke and other stroke-related procedures was statistically significant (p < .0001). Conclusion: To our knowledge, this is the first study to evaluate trends in Medicare reimbursement for stroke care. When adjusted for inflation, Medicare reimbursement for included procedures has steadily decreased from 2000 to 2019. Increased awareness of these trends is important to assure continued access to quality stroke care in the United States.

Potentialities of Plastic and Reconstructive Microsurgery in Treatment of Patients with Pathology of Large Joints of Extremities

2013 ◽  
Vol 20 (2) ◽  
pp. 12-19
Author(s):  
R. M Tikhilov ◽  
D. I Kutyanov ◽  
L. A Rodomanova ◽  
A. Yu Kochish
Keyword(s):  
Inflammatory Process ◽  
Soft Tissues ◽  
Lower Extremities ◽  
High Technology ◽  
Joint Movement ◽  
Pedicle Flap ◽  
Reconstructive Microsurgery ◽  
Upper And Lower Extremities ◽  
Microsurgical Techniques ◽  
Reconstructive Plastic

Potentialities of reconstructive and plastic microsurgery in patients with different pathology of large joints of the extremities were studied. Results of 265 microsurgical operations with pedicle flap (65.7%) and free tissue (34.3%) grafting were assessed. It was shown that use of microsurgical techniques provided reconstruction of full value para-articular soft tissues, increased range of joint movement and created the conditions for effective arrest of local inflammatory process. Besides, they possessed potentialities for the performance and increase of the efficacy in arthroplasty and some other high technology operations on large joints. The more distally the joint is located the higher is the need in reconstructive-plastic microsurgical operations and free tissue grafting on upper and lower extremities.

Effect of health insurance on direct hospitalisation costs for in-patients with ischaemic stroke in China

2018 ◽  
Vol 42 (1) ◽  
pp. 39 ◽  
Author(s):  
Ma Yong ◽  
Xiong Xianjun ◽  
Li Jinghu ◽  
Fang Yunyun
Keyword(s):  
Health Insurance ◽  
Cerebrovascular Disease ◽  
Financial Burden ◽  
Reimbursement Rate ◽  
Financial Investment ◽  
Hospitalised Patients ◽  
The Government ◽  
Set Up ◽  
The Cost ◽  
Out Of Pocket Costs

Objectives The aim of the present study was to determine the direct medical costs of hospitalisations for ischaemic stroke (IS) in-patients with different types of health insurance in China and to analyse the demographic characteristics of hospitalised patients, based on data supplied by the China Health Insurance Research Association (CHIRA). Methods A nationwide and cross-sectional sample of IS in-patients with International Classifications of Diseases 10th Revision (ICD-10) Code I63 who were ensured under either the Basic Medical Insurance Scheme for Employees (BMISE) or the Basic Medical Insurance Scheme for Urban Residents (BMISUR) was extracted from the CHIRA claims database. A retrospective analysis was used with regard to patient demographics, total hospital charges and costs. Results Of the 49588 hospitalised patients who had been diagnosed with IS in the CHIRA claims database, 28850 (58.2%) were men (mean age 67.34 years) and 20738 (41.8%) were women (mean age 69.75 years). Of all patients, 40347 (81.4%) were insured by the BMISE, whereas 8724 (17.6%) were insured by the BMISUR; the mean age of these groups was 68.55 and 67.62 years respectively. For BMISE-insured in-patients, the cost per hospitalisation was RMB10131 (95% confidence interval (CI) 10014–10258), the cost per hospital day was RMB787 (95% CI 766–808), the out-of-pocket costs per patient were RMB2346 (95% CI 2303–2388) and the reimbursement rate was 74.61% (95% CI 74.48–74.73%). For BMISUR-insured in-patients the cost per hospitalisation was RMB7662 (95% CI 7473–7852), the cost per hospital day was RMB744 (95% CI 706–781), the out-of-pocket costs per patient were RMB3356 (95% CI 3258–3454) and the reimbursement rate was 56.46% (95% CI 56.08–56.84%). Conclusions Costs per hospitalisation, costs per hospital day and the reimbursement rate were higher for BMISE- than BMISUR-insured in-patients, but BMISE-insured patients had lower out-of-pocket costs. The financial burden was higher for BMISUR- than BMISE-insured in-patients. For BMISUR-insured in-patients, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursements to meet the health needs of in-patients with different income levels. What is known about the topic? Cardiovascular and cerebrovascular diseases are major non-communicable diseases affecting the health of the Chinese population. The China Health Statistics Yearbook (2013) reported that across all in-patients, 195million (5.82%) had been discharged with a diagnosis of cerebrovascular disease. Of these, 118million had IS, accounting for 60.51% of all in-patients with cerebrovascular disease and 54.97% of hospitalisation costs for all cerebrovascular disease in-patients. After the two basic insurance systems, namely the BMISE and BMISUR, had been established, the out-of-pocket expenses for patients were reduced. However, to date there have been no studies investigating how the different types of health insurance (i.e. the BMISE and the BMISUR) affected the costs of treatment of IS in-patients in China. What does this paper add? This paper reports the direct costs for patients diagnosed with IS based on data supplied by the CHIRA. Direct hospitalisation costs depending on the type of insurance cover, age and gender were also evaluated. What are the implications for practitioners? The present study found that the personal financial burden of disease treatment was higher for in-patients insured under the BMISUR than BMISE. For in-patients insured under the BMISUR, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursement rates to meet the health needs of patients with different incomes.

Laboratory training in microsurgical techniques and microvascular anastomosis

1999 ◽  
Vol 2 (3) ◽  
pp. 149-158 ◽  
Author(s):  
Yasuhiro Yonekawa ◽  
Rosmarie Frick ◽  
Peter Roth ◽  
Ethan Taub ◽  
Hans-Georg Imhof
Keyword(s):  
Microvascular Anastomosis ◽  
Microsurgical Techniques ◽  
Laboratory Training

Valuing neurosurgery services: Part I. The historical development and interrelationships of Current Procedural Terminology and the Medicare Fee Schedule

2002 ◽  
Vol 12 (4) ◽  
pp. 1-4
Author(s):  
James R. Bean
Keyword(s):  
Federal Budget ◽  
The United States ◽  
Government Agency ◽  
Medical Procedure ◽  
Current Procedural Terminology ◽  
Policy Changes ◽  
Medicare Payment ◽  
Medical Market ◽  
Fee Schedule ◽  
Payment Policies

Current Procedural Terminology (CPT) standardizes medical procedure coding for billing and reimbursement. Since adoption of CPT coding as the basis for the Medicare Fee Schedule (MFS) in 1992, CPT coding policies and policy changes have been influenced not only by medical necessity and customary practice, but also increasingly by Medicare payment policies. The MFS created regulatory price control in the United States medical market based on widespread adoption of modified MFS by private payers and benchmark MFS fees governed by federal budget limitations and set annually by government agency (Centers for Medicare and Medicaid Services).

Trends in Medicare reimbursement for neurosurgical procedures: 2000 to 2018

2020 ◽  
Vol 132 (2) ◽  
pp. 649-655 ◽  
Author(s):  
Jack M. Haglin ◽  
Kent R. Richter ◽  
Naresh P. Patel
Keyword(s):  
Growth Rate ◽  
Consumer Price Index ◽  
The United States ◽  
Annual Growth ◽  
Neurosurgical Procedures ◽  
Annual Growth Rate ◽  
Medicare Reimbursement ◽  
Reimbursement Rate ◽  
Compound Annual Growth Rate ◽  
Percent Change

OBJECTIVEThere is currently a paucity of literature evaluating procedural reimbursements and financial trends in neurosurgery. A comprehensive understanding of the economic trends and financial health of neurosurgery is important to ensure the sustained success and growth of the specialty moving forward. The purpose of this study was to evaluate monetary trends of the 10 most common spinal and cranial neurosurgical procedures in Medicare reimbursement rates from 2000 to 2018.METHODSThe Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for each of the top 10 most utilized Current Procedural Terminology codes in both spinal and cranial neurosurgery, and comprehensive reimbursement data were extracted. The raw percent change in Medicare reimbursement rate from 2000 to 2018 was calculated for each procedure and averaged. This was then compared to the percent change in consumer price index over the same time. Using data adjusted for inflation, trend analysis was performed for all included procedures. Adjusted R-squared and both the average annual and the total percent change in reimbursement were calculated based on these adjusted trends for all included procedures. Likewise, the compound annual growth rate was calculated for all procedures.RESULTSWhen all reimbursement data were adjusted for inflation, the average reimbursement for all procedures decreased by an average of 25.80% from 2000 to 2018. From 2000 to 2018, the adjusted reimbursement rate for all included procedures decreased by an average of 1.59% each year and experienced an average compound annual growth rate of −1.66%, indicating a steady annual decline in reimbursement when adjusted for inflation.CONCLUSIONSThis is the first study to evaluate comprehensive trends in Medicare reimbursement in neurosurgery. When adjusted for inflation, Medicare reimbursement for all included procedures has steadily decreased from 2000 to 2018, with similar rates of decline observed between cranial and spinal neurosurgery procedures. Increased awareness and consideration of these trends will be important moving forward for policy makers, hospitals, and neurosurgeons as continued progress is made to advance agreeable reimbursement models that allow for the sustained growth of neurosurgery in the United States.

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