Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Neurosurgery. 2023 May 1;92(5):963-970. doi: 10.1227/neu.0000000000002306. Epub 2023 Jan 9.
An estimated 50 million Americans receive Medicare health care coverage. Prior studies have established a downward trend in Medicare reimbursement for commonly billed surgical procedures, but it is unclear whether these trends hold true across all neurosurgical procedures.
To assess trends in utilization, charges, and reimbursement by Medicare for neurosurgical procedures after passage of the Affordable Care Act in 2010.
We review yearly Physician/Supplier Procedure Summary datasets from the Centers for Medicare and Medicaid Services for all procedures billed by neurosurgeons to Medicare Part B between 2011 and 2019. Procedural coding was categorized into cranial, spine, vascular, peripheral nerve, and radiosurgery cases. Weighted averages for charges and reimbursements adjusted for inflation were calculated. The ratio of the weighted mean reimbursement to weighted mean charge was calculated as the reimbursement-to-charge ratio, representing the proportion of charges reimbursed by Medicare.
Overall enrollment-adjusted utilization decreased by 12.1%. Utilization decreased by 24.0% in the inpatient setting but increased by 639% at ambulatory surgery centers and 80.2% in the outpatient setting. Inflation-adjusted, weighted mean charges decreased by 4.0% while reimbursement decreased by 4.6%. Procedure groups that saw increases in reimbursement included cervical spine surgery, cranial functional and epilepsy procedures, cranial pain procedures, and endovascular procedures. Ambulatory surgery centers saw the greatest increase in charges and reimbursements.
Although overall reimbursement declined across the study period, substantial differences emerged across procedural categories. We further find a notable shift in utilization and reimbursement for neurosurgical procedures done in non-inpatient care settings.
约有 5000 万美国人接受联邦医疗保险（Medicare）的医疗保健服务。先前的研究已经确定了常见计费手术的 Medicare 报销金额呈下降趋势，但尚不清楚这些趋势是否适用于所有神经外科手术。
评估 2010 年《平价医疗法案》（Affordable Care Act）通过后， Medicare 对神经外科手术的利用、收费和报销趋势。
我们审查了 2011 年至 2019 年间 Medicare 第 B 部分由神经外科医师向 Medicare 报销的所有程序的 Medicare 和医疗补助服务中心（Centers for Medicare and Medicaid Services）每年医师/供应商程序摘要数据集。对程序编码进行了分类，分为颅、脊柱、血管、周围神经和放射手术病例。对通货膨胀进行了调整的收费和报销的加权平均值。计算加权平均报销与加权平均收费的比率，作为 Medicare 报销的收费比例。
总体上，调整后的注册利用率下降了 12.1%。住院治疗的利用率下降了 24.0%，但在门诊手术中心增加了 639%，在门诊治疗中增加了 80.2%。经通货膨胀调整后，加权平均收费下降了 4.0%，而报销下降了 4.6%。报销增加的手术组包括颈椎手术、颅功能性和癫痫手术、颅痛手术和血管内手术。门诊手术中心的收费和报销增长幅度最大。
尽管在整个研究期间报销总额下降，但在手术类别方面出现了显著差异。我们还发现，非住院治疗环境中神经外科手术的利用和报销发生了显著转变。
