Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, Texas.
Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, Texas.
Ann Thorac Surg. 2023 Oct;116(4):845-852. doi: 10.1016/j.athoracsur.2023.06.023. Epub 2023 Jul 8.
Given the uncertainty of US health care finances, an understanding of reimbursement trends has become increasingly important in the field of cardiac surgery. We aimed to assess Medicare reimbursement trends for common cardiac surgical procedures from 2000 to 2022.
Reimbursement data were extracted from the Centers for Medicare and Medicaid Services Physician Fee Schedule Look-Up Tool during the study period for 6 common cardiac operations: aortic valve replacement, mitral valve repair and replacement, tricuspid valve replacement, Bentall procedure, and coronary artery bypass grafting. Reimbursement rates were adjusted for inflation to 2022 US dollars using the Consumer Price Index. Total percentage change and compound annual growth rate were calculated. A split-time analysis was performed to assess trends before and after 2015. Least squares and linear regressions were performed. The R value was calculated for each procedure, and slope was used to determine change in reimbursements over time.
Inflation-adjusted reimbursement decreased by 34.1% during the study period. The overall compound annual growth rate was -1.8%. Reimbursement trends differed by procedure (P < .001), with all reimbursements trending down (R > 0.62), except for mitral valve replacement (P = .21) and tricuspid valve replacement (P = .43). Coronary artery bypass grafting decreased the most (-44.4%), followed by aortic valve replacement (-40.1%), mitral valve repair (-38.5%), mitral valve replacement (-29.8%), Bentall procedure (-28.5%), and tricuspid valve replacement (-25.3%). In split-time analysis, reimbursement rates did not significantly change from 2000 to 2015 (P = .24) but decreased significantly from 2016 to 2022 (P = .001).
Medicare reimbursement significantly decreased for most cardiac surgical procedures. These trends justify further advocacy by The Society of Thoracic Surgeons to maintain access to quality cardiac surgical care.
考虑到美国医疗保健财务的不确定性，了解报销趋势在心脏外科领域变得越来越重要。我们旨在评估 2000 年至 2022 年期间常见心脏手术的医疗保险报销趋势。
在研究期间，从医疗保险和医疗补助服务中心医师费用表查询工具中提取了 6 种常见心脏手术的报销数据：主动脉瓣置换术、二尖瓣修复和置换术、三尖瓣置换术、Bentall 手术和冠状动脉旁路移植术。使用消费者价格指数将报销率调整为 2022 年的美元。计算总百分比变化和复合年增长率。进行分割时间分析以评估 2015 年前后的趋势。进行最小二乘法和线性回归。为每个程序计算 R 值，斜率用于确定随时间的报销变化。
在研究期间，经通胀调整后的报销减少了 34.1%。总体复合年增长率为-1.8%。报销趋势因手术而异（P<0.001），除二尖瓣置换术（P=0.21）和三尖瓣置换术（P=0.43）外，所有手术的报销均呈下降趋势（R>0.62）。冠状动脉旁路移植术减少最多（-44.4%），其次是主动脉瓣置换术（-40.1%）、二尖瓣修复术（-38.5%）、二尖瓣置换术（-29.8%）、Bentall 手术（-28.5%）和三尖瓣置换术（-25.3%）。在分割时间分析中，从 2000 年到 2015 年，报销率没有显着变化（P=0.24），但从 2016 年到 2022 年显着下降（P=0.001）。
大多数心脏外科手术的医疗保险报销显着减少。这些趋势证明了胸外科医生协会进一步倡导维持高质量心脏外科护理的合理性。
