State Variations in Public Payer Reimbursement for Common Plastic Surgery Procedures

Area of Science:

• Health Economics
• Surgical Reimbursement Policy
• Healthcare Disparities

Background:

• Plastic surgeons show reduced participation in Medicare and Medicaid.
• Disparities in reimbursement rates between Medicare and Medicaid for surgical procedures are documented.
• Variations in reimbursement for plastic surgery procedures require investigation.

Purpose of the Study:

• To analyze national variations in Medicare and Medicaid reimbursement for common plastic surgery procedures.
• To quantify the differences in payment rates between Medicare and Medicaid.
• To understand the implications of reimbursement disparities on access to care.

Main Methods:

• Utilized 2017 Medicare and Medicaid reimbursement data from CMS and state fee schedules.
• Examined eight common plastic surgery procedures nationwide.
• Calculated reimbursement differences and compared payer payments to work relative value units (wRVUs).

Main Results:

• Medicaid reimbursement was significantly lower than Medicare, with a median national discount of -25% (-$16.09 per wRVU).
• Medicaid offered higher median reimbursement per wRVU than Medicare in only five states.
• Substantial variations (>15%) in Medicaid-to-Medicare reimbursement ratios were found in 28 states.

Conclusions:

• Significant discrepancies exist between Medicare and Medicaid reimbursement for plastic surgery.
• Intra-state variations in Medicaid reimbursement suggest opaque policy differences.
• Reimbursement disparities likely exacerbate access to care issues for vulnerable patient groups.