Division of Vascular Surgery, University of Massachusetts, Worcester, MA.
Division of Vascular Surgery, University of Texas at San Antonio, San Antonio, TX.
Ann Vasc Surg. 2021 May;73:446-453. doi: 10.1016/j.avsg.2020.11.018. Epub 2020 Dec 24.
Reimbursements for professional services performed by clinicians are under constant scrutiny. The value of a vascular surgeon's services as measured by work relative value units (wRVUs) and professional reimbursement has decreased for some of the most common procedures performed. Hospital reimbursements, however, often remain stable or increases. We sought to evaluate fistulagrams as a case study and hypothesized that while wRVUs and professional reimbursements decrease, hospital reimbursements for these services increased over the same time period.
Medicare 5% claims data were reviewed to identify all fistulagrams with or without angioplasty or stenting performed between 2015 and 2018 using current procedural terminology codes. Reimbursements were classified into 3 categories: medical center (reimbursements made to a hospital for a fistulagram performed as an outpatient procedure), professional (reimbursement for fistulagrams based on compensation for procedures: work RVUs, practice expense RVU, malpractice expense RVU), and office-based laboratory (OBL, reimbursement for fistulagrams performed in an OBL setting). Medicare's Physician Fee Schedule was used to calculate wRVU and professional reimbursement. Medicare's Hospital Outpatient Prospective Payment System-Ambulatory Payment Classification was used to calculate hospital outpatient reimbursement.
From 2015 to 2018, we identified 1,326,993 fistulagrams. During this study period, vascular surgeons experienced a 25% increase in market share for diagnostic fistulagrams. Compared with 2015, total professional reimbursements from 2017 to 2018 for all fistulagram procedures decreased by 41% (-$10.3 million) while OBL reimbursement decreased 29% (-$42.5 million) and wRVU decreased 36%. During the same period, medical center reimbursement increased by 6.6% (+$14.1 million).
Vascular surgeons' contribution to a hospital may not be accurately reflected through traditional RVU metrics alone. Vascular surgeons performed an increasing volume of fistulagram procedures while experiencing marked reductions in wRVU and reimbursement. Medical centers, on the other hand, experienced an overall increase in reimbursement during the same time period. This study highlights that professional reimbursements, taken in isolation and without consideration of medical center reimbursement, undervalues the services and contributions provided by vascular surgeons.
临床医生提供的专业服务的报销一直受到严格审查。一些最常见的手术的工作相对价值单位 (wRVU) 和专业报销衡量的血管外科医生的服务价值已经下降。然而，医院的报销通常保持稳定或增加。我们试图将血管造影作为一个案例研究，并假设尽管 wRVU 和专业报销减少，但这些服务的医院报销在同一时期增加。
使用当前程序术语代码，审查 2015 年至 2018 年间进行的所有带有或不带有血管成形术或支架置入术的血管造影术的 Medicare 5% 索赔数据。报销分为三类：医疗中心（医院对门诊进行的血管造影术进行的报销）、专业（基于程序补偿的血管造影术报销：工作 RVU、实践费用 RVU、医疗事故费用 RVU）和基于办公室的实验室 (OBL，在 OBL 环境中进行的血管造影术报销)。使用 Medicare 医师费用表计算 wRVU 和专业报销。使用 Medicare 医院门诊前瞻性支付系统-门诊支付分类计算医院门诊报销。
从 2015 年到 2018 年，我们确定了 1326993 例血管造影术。在本研究期间，血管外科医生在诊断性血管造影术的市场份额增加了 25%。与 2015 年相比，2017 年至 2018 年所有血管造影术程序的总专业报销减少了 41%（-1030 万美元），而 OBL 报销减少了 29%（-4250 万美元），wRVU 减少了 36%。在此期间，医疗中心报销增加了 6.6%（+1410 万美元）。
仅通过传统 RVU 指标可能无法准确反映血管外科医生对医院的贡献。血管外科医生在经历 wRVU 和报销大幅减少的情况下，进行了越来越多的血管造影术。另一方面，医疗中心在同一时期的报销总额有所增加。本研究强调，专业报销在没有考虑医疗中心报销的情况下单独考虑，低估了血管外科医生提供的服务和贡献。
