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Medicare reimbursement for common general surgery procedures has declined over the last decade

Published:October 31, 2021DOI:https://doi.org/10.1016/j.amjsurg.2021.10.040

      Highlights

      • Medicare reimbursement for general surgery procedures lags behind inflation.
      • Trends in Medicare reimbursement are independent of operative approach.
      • Cholecystectomy adjusted reimbursement has decreased by >10% over the last decade.

      Abstract

      Background

      The Centers for Medicare and Medicaid Services proposed reimbursement cuts for operations in 2021. Literature examining reimbursement for common operations is scarce.

      Methods

      Reimbursement rates were abstracted (2011–2021). Trends in reimbursement rates were analyzed using linear regression.

      Results

      From 2011 to 2021, the national inflation rate was 16.3%. Unadjusted reimbursement rates for open and laparoscopic inguinal hernia repairs increased by 6.5% and 7.2%, respectively. There was an increase in unadjusted reimbursement for open appendectomies of 5.1% and 6.1% for laparoscopic. Unadjusted reimbursement for open cholecystectomies increased by 4.4%, but decreased by 6.8% for laparoscopic. When adjusted to 2021 values, reimbursement for all six operations decreased. Laparoscopic and open cholecystectomies experienced the largest decreases (19.8%, 10.2%).

      Conclusion

      Since 2011, there have been decreases in adjusted reimbursement for three common operations, independent of operative approach. Awareness of trends in reimbursement rates should be a priority to ensure sustainable general surgical care.

      Keywords

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      References

      1. Fact sheet: Aging in the United States. Population Reference Bureau. Accessed December 13, 2020. https://www.prb.org/aging-unitedstates-fact-sheet/.

      2. American College of Surgeons Strongly Opposes Proposed Medicare Physician Fee Schedule. American College of Surgeons, 2021 (Accessed)
        • Robeznieks A.
        Congress Provides Relief on Medicare Payment; Passes Surprise Billing.
        American Medical Association, 2020 (Accessed)
      3. Rural hospital closures. The cecil G. Sheps center for health services research.
        (Accessed)
        • Stone W.A.
        COVID surge is overwhelming U.S. Hospitals, raising fears of rationed care. NPR.
        (Accessed)
        • Ellison E.C.
        • Pawlik T.M.
        • Way D.P.
        • Satiani B.
        • Williams T.E.
        Ten-year reassessment of the shortage of general surgeons: increases in graduation numbers of general surgery residents are insufficient to meet the future demand for general surgeons.
        Surgery. 2018; 164: 726-732https://doi.org/10.1016/j.surg.2018.04.042
        • Hoballah J.J.
        • Liao J.
        • Salameh M.
        • Weigel R.J.
        Physician reimbursement for general surgical procedures in the last century: 1906-2006.
        J Am Coll Surg. 2008; 206: 670-677https://doi.org/10.1016/j.jamcollsurg.2007.11.008
        • Haglin J.M.
        • Richter K.R.
        • Patel N.P.
        Trends in Medicare reimbursement for neurosurgical procedures: 2000 to 2018.
        J Neurosurg. 2019; 132: 649-655https://doi.org/10.3171/2018.8.JNS181949
        • Martin A.B.
        • Hartman M.
        • Lassman D.
        • Catlin A.
        National health care spending in 2019: steady growth for the fourth consecutive year.
        Health Aff. 2020; 40: 14-24https://doi.org/10.1377/hlthaff.2020.02022
        • Himmelstein D.U.
        • Campbell T.
        • Woolhandler S.
        Health care administrative costs in the United States and Canada, 2017.
        Ann Intern Med. 2020; 172: 134-142https://doi.org/10.7326/M19-2818
        • Smoldt R.
        • Cortese D.
        • Landman N.
        • Gans D.
        Medicare physician payment: why it's still A problem, and what to do now. Health affairs blog.
        (Accessed)
      4. Relative Value Units (RVUs). National Health Policy Forum, 2015 (Accessed)
        • Hayon S.
        • Deal A.
        • Tan H.-J.
        • et al.
        Is the relative value of surgeon effort equal across surgical specialties?.
        Surgery. 2020; 168: 365-370https://doi.org/10.1016/j.surg.2020.04.018
        • Clemens J.
        • Gottlieb J.D.
        In the shadow of a giant: medicare's influence on private physician payments.
        J Polit Econ. 2017; 125: 1-39https://doi.org/10.1086/689772
      5. Lopez E, Neuman T, Jacobson G, Levitt L. How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature. Kaiser Family Foundation. Accessed October 16, 2021. https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/.