Billing and Utilization Trends in Reconstructive Microsurgery Indicate Worsening Access to Care

Area of Science:

• Microsurgery
• Health Economics
• Medical Billing

Background:

• Medicare reimbursements for microsurgery have declined over the past 20 years.
• Physician expenses and the cost of advanced technology in microsurgery are increasing.
• This trend may lead to higher hospital charges, creating financial barriers to patient care.

Purpose of the Study:

• To analyze billing trends in microsurgery from 2013 to 2020.
• To investigate the relationship between Medicare reimbursements and hospital charges for microsurgical procedures.
• To assess the implications of these trends on patient access to care.

Main Methods:

• Utilized the 2013-2020 Medicare Provider Utilization and Payment Data.
• Extracted data for 16 CPT codes related to microsurgery.
• Calculated service counts, hospital charges, reimbursements, and charge-to-reimbursement ratios (CRRs).

Main Results:

• Microsurgical procedure counts decreased by 15.0% overall.
• Average reimbursement increased by 16.7% ($618 to $722), while mean charges rose by 35.6% ($3,200 to $4,340).
• The charge-to-reimbursement ratio (CRR) increased by 15.4%, with significant rises in free flap breast procedures (47.1%) and lymphangiotomy (28.6%).

Conclusions:

• Hospital charges for microsurgery are increasing faster than Medicare reimbursements.
• Rising costs and inadequate reimbursement rates may hinder access for economically disadvantaged patients.
• Policy recommendations include updating Medicare reimbursement rates and regulating hospital charge markups.