Are Surgeons Being Paid Fairly by Medicaid? A National Comparison of Typical Payments for General Surgeons

Abstract

These findings call into question the fairness of MCD reimbursement for general surgery services in the United States. This discount to MCR could act as a disincentive for surgeons to care for some patients, based on the state of residence. These unexplained discounts could have considerable long-term effects for patients dependent on the MCD program. Our study should act as a stimulus for states to examine their payment methodologies to provide more uniform and fairer payments for surgical procedures.

State Variation in Medicaid Reimbursements for Orthopaedic Surgery

“…Although some state-level variation is expected because of differences in population, policies, historic policy, and labor costs, the magnitude of these variations may lead to disparities among states in quality and access to care. In 2015, Medicaid reimbursement for procedures performed by general surgeons deviated from Medicare by over $1,000 in both positive and negative directions 2 . In a health-care environment increasingly geared toward rewarding value, reimbursement should reflect how states value physicians' work.…”

The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy

“…In its current form, Medicaid financing does offer participating states some flexibility with regard to how participating physicians are reimbursed, with the overarching aim of optimizing health care access for beneficiaries. 43 Although remuneration parity with Medicare and commercial payers is not feasible, increasing reimbursement rates to levels that encourage the enlistment of an array of care providers such as plastic surgeons will considerably improve disparities in IBR use. In a recent study, organization-level characteristics such as available staffing, system inefficiencies, and limited abilities to invest in care improvement activities were identified as potential drivers of the delivery of higher cost, lower quality care.…”

“…At the policy level, prior research has suggested reduced Medicaid physician reimbursement rates compared with Medicare and commercial payers as a cause of lower access for Medicaid enrollees. 43 Although remuneration parity with Medicare and commercial payers is not feasible, increasing reimbursement rates to levels that encourage the enlistment of an array of care providers such as plastic surgeons will considerably improve disparities in IBR use. [38][39][40] Economic incentives are acknowledged to be a powerful determinant of physician behavior.…”

Concurrent Proximal Fractures Are Rare in Distal Forearm Fractures: A National Cross-sectional Study

“…Finally, to account for potential variation in the actual cost of the additional imaging by facility, state, and payer, we performed a sensitivity analysis varying the cost by 75% and 150%. These differences were determined by the reported magnitude of differences in commercial insurance and Medicaid reimbursement compared to Medicare reimbursement 14,15…”