Gong Jung Ho, Long Chao, Eltorai Adam E M, Sanghavi Kavya K, Giladi Aviram M
The Warren Alpert Medical School of Brown University, Providence, RI, USA.
MedStar Union Memorial Hospital, Baltimore, MD, USA.
Hand (N Y). 2023 Oct;18(7):1190-1199. doi: 10.1177/15589447221077367. Epub 2022 Mar 3.
Hospitals and providers may increase hand surgery charges to compensate for decreasing reimbursement. Higher charges, combined with increasing utilization of ambulatory surgical centers (ASCs), may threaten the accessibility of affordable hand surgery care for uninsured and underinsured patients.
We queried the Physician/Supplier Procedure Summary to collect the number of procedures, charges, and reimbursements of hand procedures from 2010 to 2019. We adjusted procedural volume by Medicare enrollment and monetary values to the 2019 US dollar. We calculated weighted means of charges and reimbursement that were then used to calculate reimbursement-to-charge ratios (RCRs). We calculated overall change and from 2010 to 2019 for all procedures and stratified by procedural type, service setting, and state where service was rendered.
Weighted mean charges, reimbursement, and RCRs changed by + 21.0% (from $1,227 to $1,485; = 0.93), +10.8% (from $321 to $356; = 0.69), and -8.4% (from 0.26 to 0.24; = 0.76), respectively. The Medicare enrollment-adjusted number of procedures performed in ASCs increased by 63.8% ( = 0.95). Trends in utilization and billing varied widely across different procedural types, service settings, and states.
Charges for hand surgery procedures steadily increased, possibly reflecting an attempt to make up for reimbursements perceived to be inadequate. This trend places uninsured and underinsured patients at greater risk for financial catastrophe, as they are often responsible for full or partial charges. In addition, procedures shifted from inpatient to ASC setting. This may further limit access to affordable hand care for uninsured and underinsured patients.
医院和医疗服务提供者可能会提高手部手术费用，以弥补报销费用的减少。较高的费用，再加上门诊手术中心（ASC）利用率的增加，可能会威胁到未参保和参保不足患者获得负担得起的手部手术治疗的机会。
我们查询了医师/供应商程序摘要，以收集2010年至2019年手部手术的手术数量、费用和报销情况。我们根据医疗保险参保人数和货币价值将手术量调整为2019年的美元价值。我们计算了费用和报销的加权平均值，然后用于计算报销与收费比率（RCR）。我们计算了2010年至2019年所有手术的总体变化，并按手术类型、服务地点和提供服务的州进行分层。
加权平均费用、报销和RCR分别变化了+21.0%（从1227美元增至1485美元；P = 0.93）、+10.8%（从321美元增至356美元；P = 0.69）和-8.4%（从0.26降至0.24；P = 0.76）。经医疗保险参保人数调整后，门诊手术中心进行的手术数量增加了63.8%（P = 0.95）。不同手术类型、服务地点和州的利用率和计费趋势差异很大。
手部手术费用稳步增加，这可能反映出试图弥补被认为不足的报销费用。这种趋势使未参保和参保不足的患者面临更大的财务灾难风险，因为他们通常要承担全部或部分费用。此外，手术从住院环境转移到了门诊手术中心环境。这可能会进一步限制未参保和参保不足患者获得负担得起的手部护理的机会。
