Kandi Lyndsay A, Jarvis Tyler L, Shrout Max, Thornburg Danielle A, Howard Michael A, Ellis Marco, Teven Chad M
University of Arizona College of Medicine, Tucson.
Mayo Clinic Alix School of Medicine, Scottsdale.
J Craniofac Surg. 2023;34(1):247-249. doi: 10.1097/SCS.0000000000008840. Epub 2022 Aug 1.
Research regarding financial trends in craniofacial trauma surgery is limited. Understanding these trends is important to the evolvement of suitable reimbursement models in craniofacial plastic surgery. The purpose of this study was to evaluate the trends in Medicare reimbursement rates for the top 20 most utilized surgical procedures for facial trauma.
The 20 most commonly utilized Current Procedural Terminology (CPT) codes for facial trauma repairs in 2018 were queried from The National Summary Data File from the Centers for Medicare & Medicaid Services (CMS). Reimbursement data for each procedure was then extracted from The Physician Fee Schedule Lookup Tool. Changes to the United States consumer price index (CPI) were used to adjust all gathered data for inflation to 2021 US dollars (USD). The average annual and the total percent change in reimbursement were calculated for the included procedures based on the adjusted trends from the years 2000 to 2021.
From 2000 to 2021, the average reimbursement for all procedures decreased by 16.6% after adjusting for inflation. Closed treatment of temporomandibular joint dislocation and closed treatment of nasal bone fractures without manipulation demonstrated the greatest decrease in mean adjusted reimbursement at -48.7% and -48.3%, respectively, while closed treatment of nasal bone fractures without stabilization demonstrated the smallest mean decrease at -1.4% during the study period. Open treatment of nasal septal fractures with or without stabilization demonstrated the greatest increase in mean adjusted reimbursement at 18.9%, while closed treatment of nasal septal fractures with or without stabilization demonstrated the smallest increase at 1.2%. The average reimbursement for all closed procedures in the top 20 decreased by 19.3%, while that for all open procedures decreased by 15.5%. The adjusted reimbursement rate for all top 20 procedures decreased by an average of 0.8% each year.
To the best of our knowledge, this is the first study to comprehensively evaluate trends in Medicare reimbursement for facial trauma surgical repairs. Adjusting for inflation, Medicare reimbursement for the top 20 most commonly utilized procedures has largely decreased from 2000 to 2021. Consideration of these trends by surgeons, hospital systems, and policymakers will be important to assure continued access to meaningful surgical facial trauma care in the United States.
关于颅面创伤手术财务趋势的研究有限。了解这些趋势对于颅面整形手术中合适的报销模式的发展很重要。本研究的目的是评估医疗保险对20种最常用面部创伤手术的报销率趋势。
从医疗保险和医疗补助服务中心（CMS）的国家汇总数据文件中查询2018年面部创伤修复最常用的20个现行程序术语（CPT）代码。然后从医师费用表查询工具中提取每个程序的报销数据。使用美国消费者价格指数（CPI）的变化将所有收集到的数据调整为2021年美元（USD）的通货膨胀后数据。根据2000年至2021年的调整趋势，计算所纳入程序的平均年度报销变化和总报销百分比变化。
从2000年到2021年，所有程序在调整通货膨胀后平均报销下降了16.6%。颞下颌关节脱位的闭合治疗和无手法操作的鼻骨骨折闭合治疗平均调整后报销下降幅度最大，分别为-48.7%和-48.3%，而无固定的鼻骨骨折闭合治疗在研究期间平均下降幅度最小，为-1.4%。有或无固定的鼻中隔骨折开放治疗平均调整后报销增加幅度最大，为18.9%，而有或无固定的鼻中隔骨折闭合治疗增加幅度最小，为1.2%。前20种所有闭合程序的平均报销下降了19.3%，而所有开放程序的平均报销下降了15.5%。前20种所有程序的调整后报销率平均每年下降0.8%。
据我们所知，这是第一项全面评估医疗保险对面部创伤手术修复报销趋势的研究。调整通货膨胀后，医疗保险对20种最常用程序的报销在2000年至2021年期间大幅下降。外科医生、医院系统和政策制定者考虑这些趋势对于确保在美国继续获得有意义的面部创伤手术护理至关重要。
