Allen Jack G, Bateman Carson, Dorius Alexander, Pang Alan, Griswold John, Springer William
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA.
Department of Surgery, University of Utah School of Medicine, Salt Lake City, USA.
Cureus. 2024 Sep 26;16(9):e70275. doi: 10.7759/cureus.70275. eCollection 2024 Sep.
Objective We analyzed changes in reimbursement rates for cardiothoracic surgery procedures from 2013 to 2022 to identify interstate variance and compare changes in reimbursement between procedural groups. Methods The Center for Medicare and Medicaid Services database was analyzed to find the 100 highest-grossing cardiothoracic surgery CPT codes from 2013 to 2022. Medicare Administrative Contractor codes were utilized to identify reimbursement for each state. The payments were adjusted for inflation utilizing the consumer price index. Procedures were weighted according to revenue, and an average yearly, inflation-adjusted percent change in reimbursement was generated for each U.S. state. Procedural groups were compared using single-factor ANOVA and post-hoc tests. Results Since 2013, the inflation-adjusted Medicare reimbursement for the top cardiothoracic surgery procedures for all U.S. states and territories decreased by a yearly average of 2.67%. Puerto Rico (-0.33%), Louisiana (-1.84%), and Alabama (-1.85%) showed the smallest change. Illinois (-3.62%), Kansas (-3.40%), and Wyoming (-3.22%) had the greatest decrease in reimbursement throughout the observed period. Pacemaker and defibrillator (mean: -20.85), valvular (-22.07%), and coronary artery bypass graft (CABG) surgery (-21.99%) procedural groups demonstrated significant differences between valvular (p=0.01) or CABG (p=0.02) and pacemaker and defibrillator. Conclusions Our study confirms that reimbursement patterns vary by geographical area. Second, geographic variation suggests an incentive for physicians to practice in states with higher Medicare reimbursement. Certain procedural groups have been affected more than others. New lobbying strategies may be needed to mitigate diminishing reimbursement so that quality of care is not impacted for Medicare beneficiaries in low reimbursement states.
我们分析了2013年至2022年心胸外科手术报销率的变化，以确定州际差异，并比较不同手术组报销情况的变化。方法：分析医疗保险和医疗补助服务中心数据库，找出2013年至2022年心胸外科手术中收入最高的100个CPT代码。利用医疗保险行政承办商代码确定每个州的报销情况。使用消费者价格指数对支付进行通胀调整。根据收入对手术进行加权，并计算每个美国州经通胀调整后的报销平均年变化百分比。使用单因素方差分析和事后检验比较不同手术组。结果：自2013年以来，美国所有州和领地心胸外科手术最高报销项目经通胀调整后的医疗保险报销平均每年下降2.67%。波多黎各（-0.33%）、路易斯安那州（-1.84%）和阿拉巴马州（-1.85%）的变化最小。在观察期内，伊利诺伊州（-3.62%）、堪萨斯州（-3.40%）和怀俄明州（-3.22%）的报销下降幅度最大。起搏器和除颤器（平均：-20.85）、瓣膜手术（-22.07%）和冠状动脉搭桥术（CABG）手术（-21.99%）手术组在瓣膜手术（p=0.01）或CABG手术（p=0.02）与起搏器和除颤器之间存在显著差异。结论：我们的研究证实，报销模式因地理区域而异。其次，地理差异表明医生有在医疗保险报销较高的州执业的动机。某些手术组受到的影响比其他组更大。可能需要新的游说策略来缓解报销减少的情况，以免低报销州的医疗保险受益人医疗质量受到影响。
