Stoffel Victoria, Shim Jalene Y, Pacella Salvatore J, Gosman Amanda A, Reid Chris M
From the Drexel University College of Medicine.
Division of Plastic Surgery, University of California, San Diego Health.
Plast Reconstr Surg. 2024 Apr 1;153(4):957-962. doi: 10.1097/PRS.0000000000010697. Epub 2023 May 16.
Over the past decade across multiple surgical specialties, Medicare reimbursement rates have remained stagnant, failing to keep pace with inflation. An internal comparison of subspecialties within plastic surgery has not yet been attempted. The goal of this study was to investigate the trends in reimbursement from 2010 to 2020 and compare across the subspecialties of plastic surgery.
The Physician/Supplier Procedure Summary was used to extract the annual case volume for the top 80% most-billed CPT codes within plastic surgery. Codes were defined into the following subspecialties: microsurgery, craniofacial surgery, breast surgery, hand surgery, and general plastic surgery. The Medicare physician reimbursement was weighted by case volume. The growth rate and compound annual growth rate were calculated and compared against an inflation-adjusted reimbursement value.
On average, inflation-adjusted growth in reimbursement for the procedures analyzed in this study was -13.5%. The largest decrease in growth rate was within the field of microsurgery (-19.2%), followed by craniofacial surgery (-17.6%). These subspecialties also had the lowest compound annual growth rate (-2.11% and -1.91%, respectively). For case volumes, microsurgery increased case volumes by an average of 3% per year, whereas craniofacial surgery increased case volumes by an average of 5% per year.
After adjusting for inflation, all subspecialties had a decrease in growth rate. This was particularly evident in the fields of craniofacial surgery and microsurgery. Consequently, practice patterns and patient access may be negatively affected. Further advocacy and physician participation in reimbursement rate negotiation may be essential to adjust for variance and inflation.
在过去十年中，多个外科专业的医疗保险报销率一直停滞不前，未能跟上通货膨胀的步伐。整形外科内部各亚专业之间尚未进行过内部比较。本研究的目的是调查2010年至2020年的报销趋势，并对整形外科的各个亚专业进行比较。
使用医生/供应商程序摘要提取整形外科中计费最多的80%的CPT代码的年病例数。代码被定义为以下亚专业：显微外科、颅面外科、乳房外科、手外科和普通整形外科。医疗保险医生报销按病例数加权。计算增长率和复合年增长率，并与经通胀调整的报销价值进行比较。
本研究分析的程序报销经通胀调整后的平均增长率为-13.5%。增长率下降最大的是显微外科领域（-19.2%），其次是颅面外科（-17.6%）。这些亚专业的复合年增长率也最低（分别为-2.11%和-1.91%）。就病例数而言，显微外科每年的病例数平均增加3%，而颅面外科每年的病例数平均增加5%。
经通胀调整后，所有亚专业的增长率均下降。这在颅面外科和显微外科领域尤为明显。因此，执业模式和患者就医机会可能会受到负面影响。进一步的宣传以及医生参与报销率谈判对于调整差异和通胀可能至关重要。
