From the Warren Alpert Medical School of Brown University, Providence, RI.
Mayo Clinic Alix School of Medicine, Rochester, MN.
Ann Plast Surg. 2022 Jan 1;88(1):93-98. doi: 10.1097/SAP.0000000000002925.
Analysis of current and past reimbursement patterns for federally funded programs is crucial to develop sustainable future payment models.
The Centers for Medicare and Medicaid Services Physician Fee Schedule was used to evaluate 26 common ophthalmic plastic and reconstructive surgery (OPRS) procedures. From 2010 to 2019, compound annual growth rate, total percent change, and annual percent change were calculated using inflation-adjusted reimbursement rates. Centers for Medicare and Medicaid Services' Physician/Supplier Procedure Summary was used to assess the surgical volume of the 26 procedures in ophthalmology and plastic surgery services.
From 2010 to 2019, total billed surgical procedures in OPRS decreased by 57.0%, affecting both ophthalmologists (-54.3%) and plastic surgeons (-80.1%). Over the study period, inflation-adjusted reimbursement rates decreased by 5.6%. Compound annual growth rate was -0.66%, and annual percent change was -0.62%. From 2010 to 2013, reimbursement rates increased by 1.8% each year. In contrast, from 2013 to 2019, reimbursement rates decreased by 1.7% each year (P < 0.0001).
From 2010 to 2019, Medicare utilization has substantially declined for OPRS procedures. Inflation-adjusted Medicare reimbursement rates have decreased for the majority of common procedures since 2013. Surgeons and policymakers need to be aware of these trends to ensure future availability of subspecialty surgical services.
分析当前和过去联邦资助项目的报销模式对于制定可持续的未来支付模式至关重要。
使用医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）医师费用表来评估 26 种常见的眼科整形和重建手术（ophthalmic plastic and reconstructive surgery，OPRS）程序。从 2010 年到 2019 年，使用通货膨胀调整后的报销率计算了复合年增长率、总百分比变化和年百分比变化。使用医疗保险和医疗补助服务中心的医师/供应商程序摘要（Centers for Medicare and Medicaid Services' Physician/Supplier Procedure Summary）评估了 26 种手术在眼科和整形手术服务中的手术量。
从 2010 年到 2019 年，OPRS 的总计费手术量下降了 57.0%，影响了眼科医生（-54.3%）和整形外科医生（-80.1%）。在研究期间，通货膨胀调整后的报销率下降了 5.6%。复合年增长率为-0.66%，年增长率为-0.62%。从 2010 年到 2013 年，报销率每年增长 1.8%。相比之下，从 2013 年到 2019 年，报销率每年下降 1.7%（P<0.0001）。
从 2010 年到 2019 年，医疗保险对 OPRS 手术的使用率大幅下降。自 2013 年以来，大多数常见手术的通货膨胀调整后医疗保险报销率都有所下降。外科医生和政策制定者需要了解这些趋势，以确保未来能够提供专科手术服务。
