Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017

Abstract

Introduction There is an absence of literature describing Medicare utilization by physiatrists, despite their key role in treating Medicare enrollees with qualifying disabilities and common neuromusculoskeletal conditions. Objective To analyze Medicare data regarding physiatrists and their beneficiaries, services, and reimbursement, as well as trends in utilization and geographic distribution. Design and Setting Retrospective analysis of publicly available Centers for Medicare & Medicaid Services data for Medicare beneficiaries receiving physiatric services from 2012 to 2017. Main Outcome Measures After adjustment for inflation, variables assessed for changes over time included provider and beneficiary demographics, total Medicare reimbursement, and the number of services provided, subsequently separated by drug and medical service metrics. Lorenz curves and Gini coefficients were computed to study reimbursement inequality. Choropleth maps were generated to assess geographic differences in physician density and reimbursement, both by state and ZIP code. Results The number of physiatrists utilizing Medicare increased from 7230 to 7895 from 2012 to 2017, whereas the average number of unique beneficiaries per clinician remained constant (307 vs. 310; p = .51). The beneficiaries' mean hierarchical conditions category (HCC) health risk score, normalized to 1.0 for the average beneficiary, increased significantly from 2012 to 2017 (1.72 vs. 1.80; p < .01). The mean Medicare reimbursement per physiatrist decreased significantly from 2012 to 2017 ($131,960 vs. $117,623; p < .001), whereas the mean number of services remained constant (3243 vs. 3077; p = .132). Botulinum toxin and baclofen injections were the two most reimbursed drug‐related services. Gini coefficients ranged from 0.52 to 0.53 for 2012 to 2017, suggesting moderate reimbursement inequality, with the 75th percentile receiving on average two times the median. Both physician density and top earners were concentrated in urban and metropolitan areas. Conclusions Despite rising health care costs and the increasing medical complexity of physiatrists' beneficiaries, Medicare payments have decreased over time. These trends are relevant to both providers and policymakers, particularly in light of unequal geographic distribution of physiatrists across the country.

Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries

“…Operationally, optimizing electronic medical record functions and educating providers leads to more accurate condition coding and, subsequently, more appropriate compensation for quality care. 5 , 8 , 22 , 23 Consistent, accurate coding should reduce individual-level variation in HCC risk scores, particularly for lifetime and clinically manageable preventable conditions. While risk scores are likely to vary with treatable condition diagnoses, variation driven by those treatable conditions that are preventable or HCCs that indicate worsening or persistent severity point to opportunities for improved care.…”

“… 21 Conversely, between 2012 and 2017, the average HCC risk score of beneficiaries with a psychiatric condition increased substantially. 22 Failure to accurately document the type and severity of conditions leads to coding irregularities, negatively impacting providers engaged in CMS value-based payment models. 6 , 9 , 23 , 24 Although the linkage between HCC risk score and providers’ reimbursement rates incentivizes coding accuracy, this evidence suggests that providers and regions suffer from coding variations.…”

A Comparative Analysis of the Common Injections Performed by Plastic Surgeons: 2012 and 2019

“…A prior study also found increased reimbursement rates for botulinum toxin injections, and justified this finding in that the neurotoxin was a more cost-effective treatment for spasticity in physical medicine and rehabilitation. 21 Another study looking at common dermatology services also reported a few significant increases in reimbursement for noninvasive procedures (ultraviolet light treatments) despite an overall decreasing trend in Medicare reimbursement. 22 Overall, there may be a trend in Medicare reimbursement toward minimally invasive, cost-effective treatments.…”