From the Johns Hopkins Hospital; and Massachusetts General Hospital.
Plast Reconstr Surg. 2022 Apr 1;149(4):711e-719e. doi: 10.1097/PRS.0000000000008906.
Ongoing concern for declining Medicare payment to surgeons may incentivize surgeons to perform more cases to maintain productivity goals. The authors evaluated trends in physician payment, patient charges, and reimbursement ratios for the most common hand and upper extremity surgical procedures.
The authors examined Medicare surgeon payment, patient charges, and surgical volume from 2012 to 2017 for 83 common surgical procedures, incorporating the year-to-year Consumer Price Index to adjust for inflation. The reimbursement ratio was calculated by dividing payment by charge. Weighted (by surgery type and volume) averages were calculated.
Total Medicare surgeon payment increased 5.6 percent to $272 million for the studied procedures. Patient charges were seven times greater than payment, growing 24 percent to $1.9 billion. Despite growth of total payment, the average overall weighted payment for a single surgery decreased 3.5 percent. The average weighted patient charge increased 8 percent, whereas the reimbursement ratio decreased 13 percent. A hand surgeon would need to perform three more cases per 100 in 2017 to maintain the same reimbursement received in 2012. After categorizing these 83 surgical procedures, distal radius fixation (>3 parts, 21 percent increase; >2-part intra-articular, extra-articular, and percutaneous pinning, 17 percent increase), bony trauma proximal to the distal radius (10 percent increase), and upper extremity flap (5 percent increase) were subject to the greatest increases in payment. Payment for forearm fasciotomy (39 percent decrease), endoscopic carpal tunnel release (30 percent decrease), and mass excisions proximal to the wrist (18 percent decrease) decreased the most.
From 2012 to 2017, despite a disproportionate increase in procedure charges, Medicare surgeon payment has not decreased substantially; however, total reimbursement is multifactorial and involves multiple sources of revenue and cost.
不断下降的联邦医疗保险支付给外科医生的费用可能会促使外科医生进行更多的手术，以维持生产效率目标。作者评估了最常见的手部和上肢手术的医生支付、患者费用和报销比例的趋势。
作者研究了 2012 年至 2017 年 83 种常见手术的医疗保险外科医生支付、患者费用和手术量，将当年的消费者价格指数纳入其中以调整通胀。报销比例是通过支付额除以收费额计算的。加权（按手术类型和数量）平均值。
研究的手术中，医疗保险外科医生的总支付增加了 5.6%，达到 2.72 亿美元。患者收费是支付额的七倍，增长了 24%，达到 19 亿美元。尽管总支付额有所增长，但单个手术的平均加权支付额却下降了 3.5%。平均加权患者收费增加了 8%，而报销比例下降了 13%。与 2012 年相比，2017 年手外科医生每 100 例手术需要多做 3 例才能获得相同的报酬。将这 83 种手术分类后，发现桡骨远端固定术（>3 部分，增长 21%；>2 部分关节内、关节外和经皮钉固定术，增长 17%）、桡骨远段骨创伤（增长 10%）和上肢皮瓣（增长 5%）的支付额增幅最大。前臂筋膜切开术（下降 39%）、内镜腕管松解术（下降 30%）和腕近端肿块切除术（下降 18%）的支付额降幅最大。
从 2012 年到 2017 年，尽管手术收费的比例不成比例地增加，但医疗保险外科医生的支付并没有大幅下降；然而，总报销是多方面的，涉及多个收入来源和成本。
