Trends in Medicare reimbursement for neurosurgical procedures: 2000 to 2018

Abstract

OBJECTIVEThere is currently a paucity of literature evaluating procedural reimbursements and financial trends in neurosurgery. A comprehensive understanding of the economic trends and financial health of neurosurgery is important to ensure the sustained success and growth of the specialty moving forward. The purpose of this study was to evaluate monetary trends of the 10 most common spinal and cranial neurosurgical procedures in Medicare reimbursement rates from 2000 to 2018.METHODSThe Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for each of the top 10 most utilized Current Procedural Terminology codes in both spinal and cranial neurosurgery, and comprehensive reimbursement data were extracted. The raw percent change in Medicare reimbursement rate from 2000 to 2018 was calculated for each procedure and averaged. This was then compared to the percent change in consumer price index over the same time. Using data adjusted for inflation, trend analysis was performed for all included procedures. Adjusted R-squared and both the average annual and the total percent change in reimbursement were calculated based on these adjusted trends for all included procedures. Likewise, the compound annual growth rate was calculated for all procedures.RESULTSWhen all reimbursement data were adjusted for inflation, the average reimbursement for all procedures decreased by an average of 25.80% from 2000 to 2018. From 2000 to 2018, the adjusted reimbursement rate for all included procedures decreased by an average of 1.59% each year and experienced an average compound annual growth rate of −1.66%, indicating a steady annual decline in reimbursement when adjusted for inflation.CONCLUSIONSThis is the first study to evaluate comprehensive trends in Medicare reimbursement in neurosurgery. When adjusted for inflation, Medicare reimbursement for all included procedures has steadily decreased from 2000 to 2018, with similar rates of decline observed between cranial and spinal neurosurgery procedures. Increased awareness and consideration of these trends will be important moving forward for policy makers, hospitals, and neurosurgeons as continued progress is made to advance agreeable reimbursement models that allow for the sustained growth of neurosurgery in the United States.

Medicare Reimbursement Trends for Facility Performed Otolaryngology Procedures: 2000–2019

“…Youssef and Vyas primarily examined Medicare claims for otolaryngology procedures from 2012 to 2016 and found similar down trending reimbursement 8 . Our findings align with trends of decreasing adjusted reimbursement rates for other surgical subspecialties, including neurosurgery, general surgery, and orthopedic surgery 5–7 . Haglin et al showed that the average reimbursement rates for the most common procedures in general surgery decreased by more than 24% from 2000 to 2018 when adjusting for inflation 6 .…”

“…Even without adjusting for inflation, the average Medicare reimbursement rate decreased by 7.0% during the study period. This is significant and different from other specialties in which reimbursement trends have not decreased if inflation is not adjusted for 5–7 . For example, reimbursement for commonly billed general surgery procedures increased by 10.1% when not correcting for inflation 6 .…”

“…This serves as a powerful tool to objectively analyze reimbursement trends for procedures reimbursed by Medicare in the United States. Recent studies have analyzed reimbursement trends in orthopedic surgery, general surgery, and neurosurgery 5–7 . There is paucity of information on reimbursement trends in otolaryngology literature.…”

A Critical Analysis of Medicare Claims for Otolaryngology Procedures

“…[23][24][25] Haglin et al demonstrated that average Medicare reimbursement rates for the most common procedures in neurosurgery decreased by .25% from 2000 to 2018 when correcting for inflation. 25 Similarly, an analysis of Medicare claims for orthopedic surgery published by Eltorai et al showed that, except for removal of an orthopedic implant, common orthopedic procedures showed a decrease in reimbursement from 2000 to 2016. 23 Additionally, previous studies have shown that for more than a decade, physicians have unilaterally absorbed more negative payment pressure than other medical provider stakeholders.…”

Analysis of 20-Year Trends in Medicare Reimbursement for Reconstructive Microsurgery

“…In the past 20 years, several surgical disciplines, including neurosurgery, orthopedics, general surgery, and plastic surgery, have witnessed a steady, significant decline in Medicare reimbursement rates. [3][4][5][6] In contrast, during this period, physician expenses have risen by over 60%. 7 Moving forward, these findings, together with a fluctuating political climate and the absence of a universally accepted payment model for health-related services, may hamper future vitality of the U.S. health care system.…”