Purpose
To evaluate trends in Medicare physician reimbursements for 20 common hand procedures/surgeries
from 2002 to 2018.
Methods
The Physician Fee Schedule Look-up Tool was used to retrieve average reimbursement
rates for 20 common hand surgeries/procedures from 2002 to 2018. All reimbursement
data were adjusted for inflation to 2018 dollars.
Results
After adjusting all data for inflation, the average reimbursement for all included
procedures decreased by 20.9% from 2002 to 2018, with a compound annual growth rate
of –3.25%. Reimbursement percentage decreases were the greatest prior to 2010 (18.4%
decrease), followed by a relative stabilization (0.94% increase) from 2010 to 2014,
after which physicians experienced a decrease of 3.9% in reimbursements between 2014
and 2018, following implementation of the Medicare Access and Children’s Health Insurance
Program Reauthorization Act in 2015. The most significant decreases in reimbursements
over time were noted for primary tendon/muscle repair (–49.6%), wrist arthroscopy
for triangular fibrocartilage repair/debridement (–44.0%), trigger finger release
in facility (–40.1%), excision of extensor tendon sheath (–38.2%), ganglion cyst excision
(–36.7%), wrist arthroscopy for diagnostic/synovial biopsy (–35.7%), wrist arthroscopy
for drainage/infection/lavage (–35.1%), wrist arthrodesis (–30.6%), endoscopic carpal
tunnel release (–27.2%), total wrist arthroplasty (–26.6%), carpometacarpal/basal
joint arthroplasty (–25.1%), and open carpal tunnel release (–22.3%). The only procedures
with a significant increase in reimbursement over time were trigger finger release
in office (+4.2%), open reduction internal fixation distal radius fracture (+2.5%),
and cubital tunnel release (+1.5%).
Conclusions
After adjusting for inflation, Medicare physician reimbursements for a major proportion
of hand surgical procedures have decreased over time.
Clinical relevance
Health-policy makers need to understand the impact of decreasing reimbursements to
develop policies of reimbursements that will not only ensure provider satisfaction
but also maintain access to care for patients.
Key words
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References
- U.S. Health Care Costs Skyrocketed to $3.65 Trillion in 2018.(Available at:)http://fortune.com/2019/02/21/us-health-care-costs-2/Date accessed: June 23, 2020
- Peter-KFF Health System Tracker.(Available at:)https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/Date accessed: June 23, 2020
- Sustainable growth rate repeal: why the "why" matters.Mo Med. 2016; 113: 10-12
- The sustainable growth rate: the elephant in the room of deficit reduction.Healthc Financ Manage. 2012; 66: 52-54
- Repeal of the sustainable growth rate: an overview for surgeons.Am J Surg. 2014; 208: 597-600
- Sustainable growth rate repealed, MACRA revealed: historical context and analysis of recent changes in Medicare physician payment methodologies.AJNR Am J Neuroradiol. 2016; 37: 210-214
- The end of the Medicare sustainable growth rate.Obstet Gynecol. 2015; 126: 613-616
- Repeal of the Medicare sustainable growth rate: direct and indirect consequences.AMA J Ethics. 2015; 17: 1053-1058
- MACRA and the future of value-based care.Neurol Clin Pract. 2016; 6: 459-465
- Will MACRA improve physician reimbursement?.N Engl J Med. 2018; 378: 1269-1271
- Physician reimbursement: from fee-for-service to MACRA, MIPS and APMs.J Med Pract Manage. 2016; 31: 266-269
- Quality measurement: a primer for hand surgeons.J Hand Surg Am. 2016; 41: 645-651
- Quality and value in an evolving health care landscape.J Hand Surg Am. 2016; 41: 794-799
- Quality assessment in hand surgery.Hand Clin. 2014; 30: 329-334
- Medicare reimbursement for general surgery procedures: 2000 to 2018.Ann Surg. 2020; 271: 17-22
- Trends in Medicare reimbursement for orthopedic procedures: 2000 to 2016.Orthopedics. 2018; 41: 95-102
- Physician Fee Schedule.(Available at:)https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/indexDate accessed: June 23, 2020
- Trends in Medicare reimbursement for neurosurgical procedures: 2000 to 2018.J Neurosurg. 2019; 132: 649-755
- After the "Doc Fix": implications of Medicare physician payment reform for academic medicine.Acad Med. 2016; 91: 900-903
- Medicare reimbursement and orthopedic surgery: past, present, and future.Curr Rev Musculoskelet Med. 2017; 10: 224-232
- Wide-awake anesthesia in the in-office procedure room: lessons learned.Hand (N Y). 2018; 13: 481-485
- Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures.J Hand Surg Am. 2017; 42: e139-e147
- A tale of two health-care systems: cost-utility analysis of open carpal tunnel release in Canada and the United States.Plast Surg (Oakv). 2017; 25: 7-13
- The influence of insurance status on access to and utilization of a tertiary hand surgery referral center.J Bone Joint Surg Am. 2012; 94: 2177-2184
- The effect of insurance type on patient access to carpal tunnel release under the Affordable Care Act.J Hand Surg Am. 2016; 41: 503-509.e1
- Waste in the US health care system: estimated costs and potential for savings.JAMA. 2019; 322: 1501-1509
- Neurologic complications in common wrist and hand surgical procedures.Orthop Rev (Pavia). 2018; 10: 7355
Further reading
- National Health Expenditure Data.(Available at:)
- Health care spending in the United States and other high-income countries.JAMA. 2018; 319: 1024-1039
Article info
Publication history
Published online: October 01, 2020
Accepted:
August 13,
2020
Received:
June 17,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
