Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

Abstract

BACKGROUND:An estimated 50 million Americans receive Medicare health care coverage. Prior studies have established a downward trend in Medicare reimbursement for commonly billed surgical procedures, but it is unclear whether these trends hold true across all neurosurgical procedures.OBJECTIVE:To assess trends in utilization, charges, and reimbursement by Medicare for neurosurgical procedures after passage of the Affordable Care Act in 2010.METHODS:We review yearly Physician/Supplier Procedure Summary datasets from the Centers for Medicare and Medicaid Services for all procedures billed by neurosurgeons to Medicare Part B between 2011 and 2019. Procedural coding was categorized into cranial, spine, vascular, peripheral nerve, and radiosurgery cases. Weighted averages for charges and reimbursements adjusted for inflation were calculated. The ratio of the weighted mean reimbursement to weighted mean charge was calculated as the reimbursement-to-charge ratio, representing the proportion of charges reimbursed by Medicare.RESULTS:Overall enrollment-adjusted utilization decreased by 12.1%. Utilization decreased by 24.0% in the inpatient setting but increased by 639% at ambulatory surgery centers and 80.2% in the outpatient setting. Inflation-adjusted, weighted mean charges decreased by 4.0% while reimbursement decreased by 4.6%. Procedure groups that saw increases in reimbursement included cervical spine surgery, cranial functional and epilepsy procedures, cranial pain procedures, and endovascular procedures. Ambulatory surgery centers saw the greatest increase in charges and reimbursements.CONCLUSION:Although overall reimbursement declined across the study period, substantial differences emerged across procedural categories. We further find a notable shift in utilization and reimbursement for neurosurgical procedures done in non-inpatient care settings.

Decreasing Reimbursement of Pituitary Tumor Surgery: An Analysis of Medicare Data From 2010 to 2020

“…The authors' results demonstrated that enrollment-adjusted utilization decreased by 12.1%, whereas reimbursement decreased by 4.6%. 7…”

“…Although there has been limited research into Medicare reimbursement trends for pituitary tumor surgery specifically, there have been a number of recent publications focused on analyzing trends in utilization, charges, and reimbursement of surgical procedures across a number of medical specialties. 7,[14][15][16][17][18][19][20] Within neurosurgery, a study Haglin et al 20 used the CMS Physician Fee Schedule Look-Up Tool to extract reimbursement data for each of the top 10 most used CPT codes in both spinal and cranial neurosurgeries. The investigators found that the average reimbursement for all procedures decreased by an average of 25.80% from 2000 to 2018 when adjusting for inflation.…”

“…The authors' results demonstrated that enrollmentadjusted utilization decreased by 12.1%, whereas reimbursement decreased by 4.6%. 7 Overall, aside from analysis of Medicare data through 2013 and commercial claims databases through 2017, there has been limited characterization into more recent nationwide trends regarding the use of microscopic and endoscopic techniques for pituitary tumor surgery. Furthermore, although there have been important recent investigations into Medicare reimbursement trends for neurosurgical procedures generally, to the best of our knowledge, there has not been an analysis examining pituitary tumor surgeries specifically.…”

“…This claims data set has been widely used to investigate nationwide trends in procedural utilization and reimbursement across a number of surgical subspecialities. [4][5][6][7] Data were aggregated and deidentified, and therefore, this study design was exempt from Institutional Review Board review. Pituitary tumor resections were identified with Current Procedure Terminology (CPT) codes of 61546, 61548, and 62165, representing an open craniotomy approach, a transnasal/ transseptal approach using a microscope, and a transnasal/transseptal approach using an endoscope, respectively.…”

“…Yearly procedural utilization was identified using the PSPS Submitted Service Count field (variable name "PSPS_SUBMITTED_SERVI-CE_CNT") and was adjusted to per million Medicare beneficiaries, in line with prior research. 6,7 Charges to Medicare were tracked using the PSPS Submitted Charge Amount (variable name "PSPS_SUBMITTED_CHARGE_AMT"), while reimbursement amounts were obtained using the PSPS Allowed Charge Amount field (variable name "PSPS_ALLOWED_CHARGE_AMT"). To control for inflation, monetary charges were measured and adjusted to the 2020 US dollar value through the US Bureau of Labor Statistics' Consumer Price Index.…”