Gong Jung Ho, Bai Ge, Vervoort Dominique, Eltorai Adam E M, Giladi Aviram M, Long Chao
From the Warren Alpert Medical School, Brown University, Providence, RI.
Department of Radiology, Brigham and Women's Hospital, Boston, MA.
Ann Plast Surg. 2022 May 1;88(5):549-554. doi: 10.1097/SAP.0000000000002990. Epub 2021 Sep 13.
This study aimed to evaluate recent trends in utilization, reimbursement, and charges for reconstructive plastic surgery procedures billed to Medicare.
We queried the Physician/Supplier Procedure Summary from the Centers for Medicare and Medicaid Services for procedures billed by plastic surgeons to Medicare Part B between 2010 and 2019. We collected service counts, charges, and reimbursements. We adjusted utilization by Medicare enrollment and adjusted monetary values for inflation. We calculated the weighted mean charge and reimbursement, which were used to calculate the reimbursement-to-charge ratio (RCR). We examined trends over time by calculating differences and performing correlation analyses of utilization, charges, reimbursement, and RCR for all procedures and for different procedural categories.
From 2010 to 2019, the overall enrollment-adjusted utilization for 912 reconstructive procedures decreased by 6.6% (r2 = 0.46). Utilization increased in certain procedural categories such as skin debridement (+36.9%, r2 = 0.48) and procedures of the breast (+114.9%, r2 = 0.48). Charges increased by 32.9% (r2 = 0.99), reimbursement decreased by 5.3% (r2 = 0.84), and RCR decreased by 28.7% (r2 = 0.99). Skin replacement/flaps/grafts procedures underwent the greatest relative decrease in reimbursement (-26.8%, r2 = 0.87). Reimbursement-to-charge ratio decreased for all procedural categories except for procedures of the auditory system.
In the past decade, Medicare utilization and reimbursement for reconstructive plastic surgery procedures decreased, whereas charges increased. This resulted in decreasing reimbursement relative to charged amounts. These findings raise concerns regarding the economic viability of providing plastic surgery services to an aging population and may impact patients' ability to access affordable plastic surgical care.
本研究旨在评估向医疗保险机构申报的整形重建手术的使用情况、报销情况及费用的近期趋势。
我们查询了医疗保险和医疗补助服务中心的医师/供应商手术摘要，获取2010年至2019年间整形外科医生向医疗保险B部分申报的手术信息。我们收集了服务次数、费用和报销金额。我们根据医疗保险参保人数调整了使用情况，并对货币价值进行了通胀调整。我们计算了加权平均费用和报销金额，用于计算报销与收费比率（RCR）。我们通过计算差异并对所有手术及不同手术类别进行使用情况、费用、报销金额和RCR的相关性分析，来研究随时间的趋势。
2010年至2019年，912例重建手术的总体参保人数调整后的使用情况下降了6.6%（r2 = 0.46）。某些手术类别如皮肤清创术（+36.9%，r2 = 0.48）和乳房手术（+114.9%，r2 = 0.48）的使用情况有所增加。费用增加了32.9%（r2 = 0.99），报销金额下降了5.3%（r2 = 0.84），RCR下降了28.7%（r2 = 0.99）。皮肤置换/皮瓣/植皮手术的报销金额相对下降幅度最大（-26.8%，r2 = 0.87）。除听觉系统手术外，所有手术类别的报销与收费比率均下降。
在过去十年中，医疗保险对整形重建手术的使用和报销减少，而费用增加。这导致报销金额相对于收费金额下降。这些发现引发了对为老年人群提供整形手术服务的经济可行性的担忧，并可能影响患者获得负担得起的整形手术护理的能力。
