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

Abstract

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.

Discussion: Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties

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W e commend Stoffel et al for their longitudinal comparison of Medicare physician reimbursement across plastic and reconstructive surgery subspecialties. 1 The authors assessed trends in subspecialty reimbursement by calculating annual revenues for the most-billed CPT codes weighted by case volume for each subspecialty. They then compared the mean actual reimbursement to the expected reimbursement after inflation.

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“…7,8 In general, inadequate reimbursement for microsurgical procedures may impact patient access through surgeons' choice of subspecialty, practice setting, and case selection. For instance, between 2003 and 2013, the average Medicare reimbursement for From the 1…”