Changes in Medicare Reimbursement for Common Gastroenterology Services Over 15 Years: 2007–2022

Khunte, Mihir; Dang, Nhu; Zhong, Anthony; Kumar, Soryan; Kamp, Kendra; Shah, Samir A.

doi:10.14309/ajg.0000000000002010

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…If healthcare costs were to exceed a calculated growth rate, the SGR would automatically truncate reimbursement the following year to match. Similar trends are evident in diagnostic radiology [12], gastroenterology [13], and orthopedic surgery [14], according to the previous literature. Declining reimbursements were even more pronounced, starting in 2007, when reductions per the DRA went into effect.…”

Section: Discussionsupporting

confidence: 84%

Trends in Medicare Reimbursement for Interventional Radiology Procedures: 2007–2020

Kumar,

Khurana,

Haglin

et al. 2023

Cureus

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Purpose: Declining physician reimbursement has been occurring across multiple specialties due to changes in Medicare legislation, including the Deficit Reduction Omnibus Reconciliation Act (DRA), the Balanced Budget Act, and the Sustainable Growth Rate. The purpose of this study was to evaluate trends in Medicare reimbursement rates for various procedural classes in interventional radiology from 2007 to 2020. Methods: Common interventional radiology procedures were selected across multiple procedural classes: gastrointestinal, biliary, urinary, fallopian dilatation, other injection/change/removal, iliac vascular, femoral/popliteal vascular, tibial/peroneal vascular, hepatobiliary, and vascular emergency. The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for current procedural terminology (CPT) codes to extract reimbursement data. All monetary data were adjusted for inflation using the United States consumer price index (CPI). The compound annual growth rate (CAGR) and average annual change in reimbursement were calculated based on these adjusted trends. Results: Aside from urinary and vascular emergency procedures, all other procedural classes experienced decreases in inflation-adjusted Medicare reimbursement from 2007 to 2020. The greatest mean decrease in reimbursement rates was observed in biliary procedures (-$21.25), while the largest mean increase in reimbursement rates was observed in vascular emergency procedures ($3.23). All procedures with increases in reimbursement rates and 36.8% of procedures with decreases in reimbursement rates have a CPT code change between 2007 and 2020. Conclusion: After accounting for inflation, reimbursement rates were shown to decline for all procedural classes except for urinary and vascular emergencies. Congressional policies, such as the Deficit Reduction Act (DRA) and the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015, may clarify some of these trends.

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Section: Discussionsupporting

confidence: 84%

Trends in Medicare Reimbursement for Interventional Radiology Procedures: 2007–2020

Kumar,

Khurana,

Haglin

et al. 2023

Cureus

Self Cite

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“…3,5,7 Similar trends have not been limited to the surgical field; a decline of 33% has been observed in common gastrointestinal services and office visits, along with a 29% decline in common emergency medicine procedures over the past years. 18,19 This study demonstrates that, after adjusting for inflation, there has been a significant decrease in weighted mean physician reimbursements for all specialties analyzed. General surgery showed the largest inflation-adjusted reimbursement decrease (−33.7%), followed by ENT (−31.5%), vascular surgery (−23.3%), and plastic surgery (−22.8%).…”

Section: Discussionmentioning

confidence: 69%

“…This trend has been noted across multiple surgical specialties including general surgery, vascular surgery, orthopedic surgery, and ENT 3,5,7 . Similar trends have not been limited to the surgical field; a decline of 33% has been observed in common gastrointestinal services and office visits, along with a 29% decline in common emergency medicine procedures over the past years 18,19 …”

Section: Discussionmentioning

confidence: 73%

Unveiling the Hidden Discrepancies Between Medicare Physician Reimbursement Rates and Inflation Across Different Surgical Specialties

Stoffel,

Camacho,

Heeb

et al. 2024

Ann Plast Surg

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Objective This study aimed to analyze the trends of Medicare physician reimbursement from 2011 to 2021 and compare the rates across different surgical specialties. Background Knowledge of Medicare is essential because of its significant contribution in physician reimbursements. Previous studies across surgical specialties have demonstrated that Medicare, despite keeping up with inflation in some areas, has remained flat when accounting for physician reimbursement. Study Design The Physician/Supplier Procedure Summary data for the calendar year 2021 were queried to extract the top 50% of Current Procedural Terminology codes based on case volume. The Physician Fee Schedule look-up tool was accessed, and the physician reimbursement fee was abstracted. Weighted mean reimbursement was adjusted for inflation. Growth rate and compound annual growth rate were calculated. Projection of future inflation and reimbursement rates were also calculated using the US Bureau of Labor Statistics. Results After adjusting for inflation, the weighted mean reimbursement across surgical specialties decreased by −22.5%. The largest reimbursement decrease was within the field of general surgery (−33.3%), followed by otolaryngology (−31.5%), vascular surgery (−23.3%), and plastic surgery (−22.8%). There was a significant decrease in median case volume across all specialties between 2011 and 2021 (P < 0.001). Conclusions This study demonstrated that, when adjusted for inflation, over the study period, there has been a consistent decrease in reimbursement for all specialties analyzed. Awareness of the current downward trends in Medicare physician reimbursement should be a priority for all surgeons, as means of advocating for compensation and to maintain surgical care feasible and accessible to all patients.

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“…23 These trends have not been exclusive to the field of surgery; a decline of 33% has been noted for common gastrointestinal services and office visits, with a decline of 29% for common emergency medicine procedures. 24,25 As these conditions continue to push physicians toward private insurance payment models, access to care will be substantially limited for patients who are covered by governmental health plans, such as those who are economically disadvantaged, dependent, or older. A small subset of areas were able to combat this issue; because of the Affordable Care Act, there has been an increase in reimbursement of 1.6% for primary care physician and 0.6% for specialty care.…”

Section: Discussionmentioning

confidence: 99%

Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties”

Stoffel

Shim

Pacella

et al. 2023

Plastic &Amp; Reconstructive Surgery

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The number of Medicare beneficiaries increases as the population of the United States grows and ages. 1 In 2010, the number of beneficiaries was estimated to be 42 million, climbing to 60 million in 2020. By 2030, it is projected that 80 million citizens will be covered by Medicare. 2 In the private insurance sector, reimbursement largely relies on the feefor-service model, which is derived from the national fee schedule established by Medicare. In procedural-based care, all procedures are reimbursed by means of their CPT code. Each CPT code is assigned a work relative value unit (wRVU). The wRVU value assigns a numeric value to a physician's "work product," which when factored in geographically, corresponds to a specific physician reimbursement. 3 Many studies have compared the relationship between inflation and physician reimbursement for procedures within other surgical specialties. [4][5][6][7][8] These studies demonstrate that Medicare reimbursement remained stagnant despite increases Background: Over the past decade across multiple surgical specialties, Medicare reimbursement rates have remained stagnant, failing to keep pace with inflation. An internal comparison of subspecialties within plastic surgery has not yet been attempted. The goal of this study was to investigate the trends in reimbursement from 2010 to 2020 and compare across the subspecialties of plastic surgery. Methods: The Physician/Supplier Procedure Summary was used to extract the annual case volume for the top 80% most-billed CPT codes within plastic surgery. Codes were defined into the following subspecialties: microsurgery, craniofacial surgery, breast surgery, hand surgery, and general plastic surgery. The Medicare physician reimbursement was weighted by case volume. The growth rate and compound annual growth rate were calculated and compared against an inflation-adjusted reimbursement value. Results: On average, inflation-adjusted growth in reimbursement for the procedures analyzed in this study was −13.5%. The largest decrease in growth rate was within the field of microsurgery (−19.2%), followed by craniofacial surgery (−17.6%). These subspecialties also had the lowest compound annual growth rate (−2.11% and −1.91%, respectively). For case volumes, microsurgery increased case volumes by an average of 3% per year, whereas craniofacial surgery increased case volumes by an average of 5% per year. Conclusions: After adjusting for inflation, all subspecialties had a decrease in growth rate. This was particularly evident in the fields of craniofacial surgery and microsurgery. Consequently, practice patterns and patient access may be negatively affected. Further advocacy and physician participation in reimbursement rate negotiation may be essential to adjust for variance and inflation.

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Changes in Medicare Reimbursement for Common Gastroenterology Services Over 15 Years: 2007–2022

Cited by 7 publications

References 8 publications

Trends in Medicare Reimbursement for Interventional Radiology Procedures: 2007–2020

Trends in Medicare Reimbursement for Interventional Radiology Procedures: 2007–2020

Unveiling the Hidden Discrepancies Between Medicare Physician Reimbursement Rates and Inflation Across Different Surgical Specialties

Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties”

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