Department of Surgery, Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona.
Mayo Clinic School of Medicine, Scottsdale, Arizona.
J Reconstr Microsurg. 2021 Oct;37(8):662-670. doi: 10.1055/s-0041-1724128. Epub 2021 Feb 25.
Microsurgery is being increasingly utilized across surgical specialties, including plastic surgery. Microsurgical techniques require greater time and financial investment compared with traditional methods. This study aimed to evaluate 20-year trends in Medicare reimbursement and utilization for commonly billed reconstructive microsurgery procedures from 2000 to 2019.
Microsurgical procedures commonly billed by plastic surgeons were identified. Reimbursement data were extracted from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services for each current procedural terminology (CPT) code. All monetary data were adjusted for inflation to 2019 U.S. dollars. The average annual and total percentage changes in reimbursement were calculated based on these adjusted trends. To assess utilization trends, CMS physician/supplier procedure summary files were queried for the number of procedures billed by plastic surgeons from 2010 to 2018.
After adjusting for inflation, the average reimbursement for all procedures decreased by 26.92% from 2000 to 2019. The greatest mean decrease was observed in CPT 20969 free osteocutaneous flaps with microvascular anastomosis (-36.93%). The smallest mean decrease was observed in repair of blood vessels with vein graft (-9.28%). None of the included procedures saw an increase in reimbursement rate over the study period. From 2000 to 2019, the adjusted reimbursement rate for all procedures decreased by an average of 1.35% annually. Meanwhile, the number of services billed to Medicare by plastic surgeons across the included CPT codes increased by 42.17% from 2010 to 2018.
This is the first study evaluating 20-year trends in inflation-adjusted Medicare reimbursement and utilization in reconstructive microsurgery. Reimbursement for all included procedures decreased over 20% during the study period, while number of services increased. Increased consideration of these trends will be important for U.S. policymakers, hospitals, and surgeons to assure continued access and reconstructive options for patients.
微创手术在包括整形外科学在内的多个外科专业领域的应用日益增多。与传统方法相比，微创手术技术需要更多的时间和资金投入。本研究旨在评估 2000 年至 2019 年期间，医疗保险（Medicare）对常见计费重建显微外科手术程序的报销和使用情况的 20 年趋势。
确定了整形外科医生常用的显微外科手术程序。从医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）的医师费用表查询工具中提取每个当前程序术语（Current Procedural Terminology，CPT）代码的报销数据。所有货币数据均按 2019 年的美元进行了通胀调整。根据这些调整后的趋势，计算了报销的平均年度和总百分比变化。为了评估使用趋势，对 CMS 医师/供应商程序汇总文件进行了查询，以获取 2010 年至 2018 年期间整形外科医生计费的程序数量。
经通胀调整后，2000 年至 2019 年期间所有程序的平均报销金额下降了 26.92%。CPT 20969 游离骨皮瓣伴微血管吻合术的降幅最大（-36.93%）。血管修复术的降幅最小（-9.28%）。在研究期间，没有任何一种程序的报销率有所增加。从 2000 年至 2019 年，所有程序的调整后报销率平均每年下降 1.35%。与此同时，整形外科医生对包括 CPT 代码在内的所有服务的计费数量从 2010 年至 2018 年增加了 42.17%。
这是第一项评估 20 年来整形显微外科手术中经通胀调整后的医疗保险报销和使用情况趋势的研究。在研究期间，所有纳入程序的报销金额下降了 20%以上，而服务数量却有所增加。美国政策制定者、医院和外科医生需要充分考虑这些趋势，以确保患者能够持续获得治疗和重建选择。
