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Terry PH, Campbell CA, Black JS, Stranix JT, Forster GL, DeGeorge BR. The Cost of Ambulatory Breast Reduction: Hospital Reimbursement Versus Surgeon Payments. Plast Surg (Oakv) 2024; 32:11-18. [PMID: 38433808 PMCID: PMC10902483 DOI: 10.1177/22925503221078716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction: Reduction mammoplasty (RM) is one of the most common operations performed in plastic surgery. While US national surgical expenditures have risen in recent years, studies have reported decreasing reimbursement rates for plastic surgeons. The purpose of this study is to characterize the trends in charges and payments for a common plastic surgery operation, ambulatory RM, for facilities and physicians. Methods: A Medicare patient records database was used to capture hospital, surgeon, and anesthesiologist charges and payments for ambulatory RM from 2005 to 2014. Values were adjusted for inflation. A ratio of hospital to surgeon charges and payments were calculated: charge multiplier (CM) and payment multiplier (PM), respectively. Charges, payments, Charlson comorbidity index, CM, and PM values were analyzed for trends. Results: This study included 1001 patients. During the study period, the facility charge for RM per patient increased from $8477 to $11,102 (31% increase; p < .0005), and the surgeon charge increased from $7088 to $7199 (2% increase; p = .0009). Facility payments increased from $3661 to $3930 (7% increase; p < .0005), and surgeon payments decreased from $1178 to $1002 (15% decrease; p < .0005). CM increased from 1.2 to 1.54, and PM increased from 3.11 to 3.92. Conclusions: Charges and payments to facilities for ambulatory RM increased disproportionately to that of surgeons, likely due in part to rising administrative costs in health care delivery. This may disincentivize plastic surgeons from offering RM at hospital-based surgical centers, limiting patient access to this operation.
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Affiliation(s)
- Peyton H. Terry
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - Christopher A. Campbell
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jonathan S. Black
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - John T. Stranix
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - Grace L. Forster
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brent R. DeGeorge
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
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Weiss SN, Gilbert GV, Gentile P, Gaughan JP, Miskiel S, Pagliaro A, Ramirez R, Fuller DA. Medicare Reimbursement in Hand and Upper Extremity Procedures: A 20-Year Analysis. Hand (N Y) 2024; 19:175-179. [PMID: 38149769 PMCID: PMC10786100 DOI: 10.1177/15589447221096708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
PURPOSE Concern exists that Medicare physician fees for procedures have decreased over the past 20 years. The Centers for Medicare & Medicaid Services (CMS) is set to re-evaluate these physician fees in the near future for concern that these procedures are overvalued. Our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2019 for the top 20 most billed hand and upper extremity surgical procedures at our institution. METHODS The financial database of a single academic tertiary care center was queried to identify the Current Procedural Terminology codes most frequently utilized in orthopedic hand and upper extremity procedures in 2019. The Physician Fee Schedule Look-Up Tool from the CMS was queried for annual physician fee data. Monetary data were adjusted for inflation using the consumer price index of Urban Research Series (CPI-U-RS) and expressed in 2019 constant US dollars (USD). The average annual and total percent change in reimbursement were calculated via linear regression for all procedures (P < .05). RESULTS Accounting for inflation, the total average physician reimbursement decreased by 20.9% from 2000 to 2019, with 12 of 20 codes decreasing by more than 20%. The greatest decrease pertained to arthrodesis of the wrist at 33.9%. Upon linear regression, all procedures were found to decrease annually, with arthrodesis of the wrist decreasing by an average of 2.3% annually over this period. CONCLUSIONS Over the past 2 decades, physician reimbursement for hand and upper extremity procedures has significantly decreased.
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Affiliation(s)
| | | | | | | | | | - Andre Pagliaro
- Rothman Orthopaedic Institute, Hamilton Township, NJ, USA
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Tiao J, Wang K, Herrera M, Rosenberg A, Carbone A, Zubizarreta N, Anthony SG. Hip Arthroscopy Trends: Increasing Patient Out-of-Pocket Costs, Lower Surgeon Reimbursement, and Cost Reduction With Utilization of Ambulatory Surgery Centers. Arthroscopy 2023; 39:2313-2324.e2. [PMID: 37100212 DOI: 10.1016/j.arthro.2023.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To (1) report on trends in immediate procedure reimbursement, patient out-of-pocket expenditures, and surgeon reimbursement in hip arthroscopy (2) compare trends in ambulatory surgery centers (ASC) versus outpatient hospitals (OH) utilization; (3) quantify the cost differences (if any) associated with ASC versus OH settings; and 4) determine the factors that predict ASC utilization for hip arthroscopy. METHODS The cohort for this descriptive epidemiology study was any patient over 18 years identified in the IBM MarketScan Commercial Claims Encounter database who underwent an outpatient hip arthroscopy, identified by Current Procedural Terminology codes, in the United States from 2013 to 2017. Immediate procedure reimbursement, patient out-of-pocket expenditure, and surgeon reimbursement were calculated, and a multivariable model was used to determine the influence of specific factors on these outcome variables. Statistically significant P values were less than .05, and significant standardized differences were more than 0.1. RESULTS The cohort included 20,335 patients. An increasing trend in ASC utilization was observed (P = .001), and ASC utilization for hip arthroscopy was 32.4% in 2017. Patient out-of-pocket expenditures for femoroacetabular impingement surgery increased 24.3% over the study period (P = .003), which was higher than the rate for immediate procedure reimbursement (4.2%; P = .007). ASCs were associated with $3,310 (28.8%; P = .001) reduction in immediate procedure reimbursement and $47 (6.2%; P = .001) reduction in patient out-of-pocket expenditure per hip arthroscopy. CONCLUSIONS ASCs provide a significant cost difference for hip arthroscopy. Although there is an increasing trend toward ASC utilization, it remains relatively low at 32.4% in 2017. Thus, there are opportunities for expanded ASC utilization, which is associated with significant immediate procedure reimbursement difference of $3,310 and patient out-of-pocket expenditure difference of $47 per hip arthroscopy case, ultimately benefiting healthcare systems, surgeons, and patients alike. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Affiliation(s)
- Justin Tiao
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Kevin Wang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Michael Herrera
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Ashley Rosenberg
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Andrew Carbone
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
| | - Nicole Zubizarreta
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Shawn G Anthony
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A..
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Gong JH, Long C, Eltorai AEM, Sanghavi KK, Giladi AM. Billing and Utilization Trends for Hand Surgery Indicate Worsening Barriers to Accessing Care. Hand (N Y) 2023; 18:1190-1199. [PMID: 35236149 PMCID: PMC10798198 DOI: 10.1177/15589447221077367] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hospitals and providers may increase hand surgery charges to compensate for decreasing reimbursement. Higher charges, combined with increasing utilization of ambulatory surgical centers (ASCs), may threaten the accessibility of affordable hand surgery care for uninsured and underinsured patients. METHODS We queried the Physician/Supplier Procedure Summary to collect the number of procedures, charges, and reimbursements of hand procedures from 2010 to 2019. We adjusted procedural volume by Medicare enrollment and monetary values to the 2019 US dollar. We calculated weighted means of charges and reimbursement that were then used to calculate reimbursement-to-charge ratios (RCRs). We calculated overall change and r2 from 2010 to 2019 for all procedures and stratified by procedural type, service setting, and state where service was rendered. RESULTS Weighted mean charges, reimbursement, and RCRs changed by + 21.0% (from $1,227 to $1,485; r2 = 0.93), +10.8% (from $321 to $356; r2 = 0.69), and -8.4% (from 0.26 to 0.24; r2 = 0.76), respectively. The Medicare enrollment-adjusted number of procedures performed in ASCs increased by 63.8% (r2 = 0.95). Trends in utilization and billing varied widely across different procedural types, service settings, and states. CONCLUSIONS Charges for hand surgery procedures steadily increased, possibly reflecting an attempt to make up for reimbursements perceived to be inadequate. This trend places uninsured and underinsured patients at greater risk for financial catastrophe, as they are often responsible for full or partial charges. In addition, procedures shifted from inpatient to ASC setting. This may further limit access to affordable hand care for uninsured and underinsured patients.
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Affiliation(s)
- Jung Ho Gong
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Chao Long
- MedStar Union Memorial Hospital, Baltimore, MD, USA
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam E. M. Eltorai
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Kavya K. Sanghavi
- MedStar Union Memorial Hospital, Baltimore, MD, USA
- MedStar Health Research Institute, Hyattsville, MD, USA
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Haglin JM, Hinckley NB, Moore ML, Deckey DG, Lai CH, Renfree KJ. Long-term Trends in Open vs Endoscopic Carpal Tunnel Release Among the Medicare Population in the United States. Hand (N Y) 2023:15589447231168977. [PMID: 37148177 DOI: 10.1177/15589447231168977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Carpal tunnel release (CTR) surgery is the most common surgery billed to Medicare by hand surgeons. As such, the purpose of this study was to evaluate trends for CTR surgeries billed to Medicare from 2000 to 2020. METHODS The publicly available Medicare Part B National Summary File from 2000 to 2020 was queried. For both open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR), the number of procedures and total Medicare reimbursement were extracted. For year 2020, the specialty of the performing surgeon was recorded. Descriptive statistics were reported. RESULTS A total of 3 429 471 CTR surgeries were performed in the Medicare population from 2000 to 2020. For these procedures, Medicare paid surgeons over $1.23 billion. During this period, there was a 101.8% increase in annual CTR procedures (91 130 in 2000, 183 911 in 2020). Further, annual volume of ECTR increased by 456.2%, and accounted for an increasing percentage of total CTR procedures (9.1% in 2012, 25.2% in 2020). The average adjusted Medicare reimbursement per procedure decreased by 1.5% for OCTR, and decreased by 11.6% for ECTR. In 2020, orthopedic surgeons performed 85.1% of CTR procedures. CONCLUSIONS The volume of CTR surgeries among the Medicare population has increased from 2000 to 2020, and ECTR is accounting for a growing proportion of surgeries. When adjusted for inflation, average reimbursement has decreased, with a greater decrease among ECTR. Orthopedic surgeons perform most of such surgeries. These trends are important to assure adequate resource allocation as treating carpal tunnel becomes more common among the aging Medicare population.
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Moran TE, Taleghani E, Wagner R, Akinleye SD, Forster GL, DeGeorge BR. Trends in Physician Payments for Hand Surgery Consultations and Clinic Visits. J Hand Surg Am 2023:S0363-5023(23)00073-4. [PMID: 36990892 DOI: 10.1016/j.jhsa.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE The primary objective of this study was to identify the trends in reimbursement for hand surgeons for new patient visits, outpatient consultations, and inpatient consultations from the years 2010-2018. In addition, we sought to investigate the influence of payer mix and coding level of service on physician reimbursement in these settings. METHODS The PearlDiver Patients Records Database was used to identify clinical encounters and their respective physician reimbursements for analysis within this study. This database was queried using Current Procedural Terminology codes to identify relevant clinical encounters for inclusion, filtered for the presence of valid demographic information and by physician specialty for the presence of a hand surgeon, and tracked by primary diagnoses. Cost data were then calculated and analyzed regarding the payer type and level of care. RESULTS In total, 156,863 patients were included in this study. The mean reimbursement for inpatient consultations, outpatient consultations, and new patient encounters increased by 92.75% ($134.85 to $259.93), 17.80% ($161.33 to $190.04), and 26.78% ($102.58 to $130.05), respectively. When normalized to 2018 dollars to adjust for inflation, the percent increases were 67.38%, 2.24%, and 10.09%, respectively. Commercial insurance reimbursed hand surgeons to a greater degree than any other payer type. Mean physician reimbursement differed depending on the level of service billed, with the level of service V reimbursing 4.41 times more than the level of service I visits for new outpatient visits, 3.66 times more for new outpatient consultations, and 3.04 times more for new inpatient consultations. CONCLUSIONS This study helps to provide physicians, hospitals, and policymakers with objective information regarding the trends in reimbursement to hand surgeons. Although this study indicates increasing reimbursements for consultations and new patient visits to hand surgeons, the margins shrink when adjusted for inflation. LEVEL OF EVIDENCE Economic Analysis IV.
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Affiliation(s)
- Thomas E Moran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Eric Taleghani
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Ryan Wagner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Sheriff D Akinleye
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Grace L Forster
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA
| | - Brent R DeGeorge
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA; Department of Plastic Surgery, University of Virginia, Charlottesville, VA.
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Physician Professional Fees Are Declining and Inpatient and Outpatient Facility Fees Are Increasing for Orthopaedic Procedures in the United States. Arthroscopy 2023; 39:384-389.e6. [PMID: 36207000 DOI: 10.1016/j.arthro.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To examine the trends in physician professional fees and inpatient and outpatient facility fees in orthopaedic surgery in the United States. METHODS Physician professional fees and inpatient and outpatient facility fees were tracked from 2008 to 2021 for the most common orthopaedic procedures in each orthopaedic subspecialty. Using common procedure codes for physician and outpatient procedures and Medicare severity diagnosis related group codes for inpatient procedures, the Medicare Physician Fee Schedules were used to obtain the national payment amounts for physician professional fees and inpatient and outpatient facility fees. Trends in fees were tracked over time after adjustment for inflation. RESULTS From 2008 to 2021, physician professional fees decreased by an average of 20%, whereas inpatient facility fees increased by 15%, and outpatient facility fees increased by 72%. The orthopaedic subspecialty with the largest decrease in physician professional fees was oncology, with an average decrease of 23.5%, followed by general orthopaedics (23.1%), and sports medicine (22.8%). The largest increase in outpatient facility fees was seen in the subspecialties of general orthopaedics (149.8%), spine (130.1%), and trauma (123.0%). CONCLUSIONS Over the past 13 years, physician professional fees for the most common orthopaedic procedures have declined while inpatient and outpatient facility fees have increased. Understanding these changes is important to the practice of orthopaedic surgery in the United States. LEVEL OF EVIDENCE IV, economic.
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Myers PL, Chung KC. Role of Health Equity Research and Policy for Diverse Populations Requiring Hand Surgery Care. Hand Clin 2023; 39:17-24. [PMID: 36402522 DOI: 10.1016/j.hcl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health equity requires allocation of resources to eliminate the systematic disparities in health, imposed on marginalized groups, which adversely impact outcomes. A socioecological approach is implemented to elucidate the role of health equity research and policy for underrepresented minority and socioeconomically disadvantaged populations. Through investigation of the individual, community, institution, and public policy, we investigate problems and propose solutions to ensure fair and just treatment of all patients requiring hand surgery.
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Affiliation(s)
- Paige L Myers
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Tiao J, Wang K, Carbone AD, Herrera M, Zubizarreta N, Gladstone JN, Colvin AC, Anthony SG. Ambulatory Surgery Centers Significantly Decrease Total Health Care Expenditures in Primary Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:97-106. [PMID: 36453721 DOI: 10.1177/03635465221136542] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) is a commonly performed orthopaedic procedure. The volume and cost of ACLR procedures are increasing annually, but the drivers of these cost increases are not well described. PURPOSE To analyze the modifiable drivers of total health care utilization (THU), immediate procedure reimbursement, and surgeon reimbursement for patients undergoing ACLR using a large national commercial insurance database from 2013 to 2017. STUDY DESIGN Descriptive epidemiology study. METHODS For this study, the cohort consisted of patients identified in the MarketScan Commercial Claims and Encounters database who underwent outpatient arthroscopic ACLR in the United States from 2013 to 2017. Patients with Current Procedural Terminology code 29888 were included. THU was defined as the sum of any payment related to the ACLR procedure from 90 days preoperatively to 180 days postoperatively. A multivariable model was utilized to describe the patient- and procedure-related drivers of THU, immediate procedure reimbursement, and surgeon reimbursement. RESULTS There were 34,862 patients identified. On multivariable analysis, the main driver of THU and immediate procedure reimbursement was an outpatient hospital as the surgical setting (US$6789 increase in THU). The main driver of surgeon reimbursement was an out-of-network surgeon (US$1337 increase). Health maintenance organization as the insurance plan type decreased THU, immediate procedure reimbursement, and surgeon reimbursement (US$955, US$108, and US$38 decrease, respectively, compared with preferred provider organization; P < .05 for all). CONCLUSION Performing procedures in more cost-efficient ambulatory surgery centers had the largest effect on decreasing health care expenditures for ACLR. Health maintenance organizations aided in cost-optimization efforts as well, but had a minor effect on surgeon reimbursement. Overall, this study increases transparency into what drives reimbursement and serves as a foundation for how to decrease health care expenditures related to ACLR.
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Affiliation(s)
- Justin Tiao
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kevin Wang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew D Carbone
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Michael Herrera
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicole Zubizarreta
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James N Gladstone
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexis C Colvin
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shawn G Anthony
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kohan J, Mangan J, Patel A. Access to Reconstructive Hand Surgery in the United States-Investigating the Obstacles: A Scoping Review. Hand (N Y) 2022:15589447221131853. [PMID: 36317809 DOI: 10.1177/15589447221131853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation. METHODS The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence. RESULTS Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature. CONCLUSIONS This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.
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Affiliation(s)
- Joshua Kohan
- The University of Vermont Robert Larner College of Medicine, Burlington, USA
| | - Jack Mangan
- The University of Vermont Robert Larner College of Medicine, Burlington, USA
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Byrd JN, Chung KC. The Hand Surgeon's Practice and the Evolving Merit-Based Incentive Payment System. J Hand Surg Am 2022; 47:890-893. [PMID: 35717421 DOI: 10.1016/j.jhsa.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/10/2022] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
The Merit-Based Incentive Payment System began scoring physicians in 2017, with implementation of payment adjustments started in 2019. The program continues to evolve, with adjustments to measures, score weighting and consideration of patient complexity. However, there remain concerns about unintended consequences of this latest value-based payment program. This review summarizes the roll-out of the program in the first performance year (2017) and changes that will have an impact on payment adjustments in the 2022 performance year. Further, it explains the need for policy informed by clinical experience to protect access for vulnerable patients.
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Affiliation(s)
- Jacqueline N Byrd
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
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United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000 to 2020. J Glaucoma 2022; 31:e90-e95. [PMID: 35939833 DOI: 10.1097/ijg.0000000000002093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate United States medicare reimbursement trends for common glaucoma procedures from 2000 to 2020. MATERIALS AND METHODS Current Procedural Terminology codes for Glaucoma procedures in the United States Centers for Medicare and Medicaid Services database were used to conduct this economic analysis. Reimbursement data from the Physician Fee Schedule look-up tool from the Centers for Medicare and Medicaid Services was compiled for the selected procedures and compensation trends were investigated after adjusting for inflation in 2020 US dollars from the unadjusted data between 2000 to 2020. RESULTS The average adjusted reimbursement for the analyzed procedures decreased by 20.5% (95% confidence interval [CI], -15.4% to -25.6%) over the twenty-year period. On average, there was a 1.03% decrease in reimbursement rates per year (95% confidence interval [CI], -0.74% to -1.33%) with an adjusted Compound Annual Growth Rate of -1.35% (95% confidence interval [CI], -1.07% to -1.64%). The results show an overall declining rate in reimbursement for the glaucoma procedures analyzed in this study. CONCLUSIONS United States medicare reimbursement for glaucoma procedures in the United States showed a significant decline between 2000 to 2020. These findings may be relevant to understanding changing practice patterns for glaucoma care.
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Nayar SK, Wollstein A, Sullivan BT, Kreulen RT, Sabharwal S, Tuffaha SH, LaPorte DM, Chen NC, Eberlin KR. Are We Working Harder for Less Pay? A Survey of Medicare Reimbursement for Hand and Upper Extremity Surgery. Plast Reconstr Surg 2022; 149:711e-719e. [PMID: 35157616 DOI: 10.1097/prs.0000000000008906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ongoing concern for declining Medicare payment to surgeons may incentivize surgeons to perform more cases to maintain productivity goals. The authors evaluated trends in physician payment, patient charges, and reimbursement ratios for the most common hand and upper extremity surgical procedures. METHODS The authors examined Medicare surgeon payment, patient charges, and surgical volume from 2012 to 2017 for 83 common surgical procedures, incorporating the year-to-year Consumer Price Index to adjust for inflation. The reimbursement ratio was calculated by dividing payment by charge. Weighted (by surgery type and volume) averages were calculated. RESULTS Total Medicare surgeon payment increased 5.6 percent to $272 million for the studied procedures. Patient charges were seven times greater than payment, growing 24 percent to $1.9 billion. Despite growth of total payment, the average overall weighted payment for a single surgery decreased 3.5 percent. The average weighted patient charge increased 8 percent, whereas the reimbursement ratio decreased 13 percent. A hand surgeon would need to perform three more cases per 100 in 2017 to maintain the same reimbursement received in 2012. After categorizing these 83 surgical procedures, distal radius fixation (>3 parts, 21 percent increase; >2-part intra-articular, extra-articular, and percutaneous pinning, 17 percent increase), bony trauma proximal to the distal radius (10 percent increase), and upper extremity flap (5 percent increase) were subject to the greatest increases in payment. Payment for forearm fasciotomy (39 percent decrease), endoscopic carpal tunnel release (30 percent decrease), and mass excisions proximal to the wrist (18 percent decrease) decreased the most. CONCLUSIONS From 2012 to 2017, despite a disproportionate increase in procedure charges, Medicare surgeon payment has not decreased substantially; however, total reimbursement is multifactorial and involves multiple sources of revenue and cost.
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Affiliation(s)
- Suresh K Nayar
- From the Johns Hopkins Hospital; and Massachusetts General Hospital
| | - Adi Wollstein
- From the Johns Hopkins Hospital; and Massachusetts General Hospital
| | - Brian T Sullivan
- From the Johns Hopkins Hospital; and Massachusetts General Hospital
| | | | - Samir Sabharwal
- From the Johns Hopkins Hospital; and Massachusetts General Hospital
| | - Sami H Tuffaha
- From the Johns Hopkins Hospital; and Massachusetts General Hospital
| | - Dawn M LaPorte
- From the Johns Hopkins Hospital; and Massachusetts General Hospital
| | - Neal C Chen
- From the Johns Hopkins Hospital; and Massachusetts General Hospital
| | - Kyle R Eberlin
- From the Johns Hopkins Hospital; and Massachusetts General Hospital
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Pollock JR, Richman EH, Estipona BI, Moore ML, Brinkman JC, Hinckley NB, Haglin JM, Chhabra A. Inflation-Adjusted Medicare Reimbursement Has Decreased for Orthopaedic Sports Medicine Procedures: Analysis From 2000 to 2020. Orthop J Sports Med 2022; 10:23259671211073722. [PMID: 35174250 PMCID: PMC8842183 DOI: 10.1177/23259671211073722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | | | | | - Jack M. Haglin
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Acuña AJ, Jella TK, Samuel LT, Schwarzkopf R, Fehring TK, Kamath AF. Inflation-Adjusted Medicare Reimbursement for Revision Hip Arthroplasty: Study Showing Significant Decrease from 2002 to 2019. J Bone Joint Surg Am 2021; 103:1212-1219. [PMID: 33764932 DOI: 10.2106/jbjs.20.01643] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Investigations into reimbursement trends for primary and revision arthroplasty procedures have demonstrated a steady decline over the past several years. Revision total hip arthroplasty (rTHA) due to infection (rTHA-I) has been associated with higher resource utilization and complexity, but long-term inflation-adjusted data have yet to be compared between rTHA-I and rTHA due to aseptic complications (rTHA-A). The present study was performed to analyze temporal reimbursement trends regarding rTHA-I procedures compared with those for rTHA-A procedures. METHODS The Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool was used to extract Medicare reimbursements associated with 1-stage and 2-stage rTHA-I as well as 1-stage rTHA-A procedures from 2002 to 2019. Current Procedural Terminology (CPT) codes for rTHA were grouped according to the American Academy of Orthopaedic Surgeons coding reference guide. Monetary values were adjusted for inflation using the consumer price index (U.S. Bureau of Labor Statistics; reported as 2019 U.S. dollars) and used to calculate the cumulative and average annual percent changes in reimbursement. RESULTS Following inflation adjustment, the physician fee reimbursement for rTHA-A decreased by a mean [and standard deviation] of 27.26% ± 3.57% (from $2,209.11 in 2002 to $1,603.20 in 2019) for femoral component revision, 27.41% ± 3.57% (from $2,130.55 to $1,542.91) for acetabular component revision, and 27.50% ± 2.56% (from $2,775.53 to $2,007.61) for both-component revision. Similarly, for a 2-stage rTHA-I, the mean reimbursement declined by 18.74% ± 3.87% (from $2,063.36 in 2002 to $1,673.36 in 2019) and 24.45% ± 3.69% (from $2,328.79 to $1,755.45) for the explantation and reimplantation stages, respectively. The total decline in physician fee reimbursement for rTHA-I ($1,020.64 ± $233.72) was significantly greater than that for rTHA-A ($580.72 ± $107.22; p < 0.00001). CONCLUSIONS Our study demonstrated a consistent devaluation of both rTHA-I and rTHA-A procedures from 2002 to 2019, with a larger deficit seen for rTHA-I. A continuation of this trend could create substantial disincentives for physicians to perform such procedures and limit access to care at the population level. LEVEL OF EVIDENCE Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tarun K Jella
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ran Schwarzkopf
- Hospital for Joint Diseases, New York University Langone Orthopedic Hospital, New York, NY
| | | | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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