Medicare billing and utilization trends in vascular surgery

Area of Science:

• Vascular Surgery
• Health Economics
• Healthcare Policy

Background:

• Medicare Part B reimbursements for surgical procedures have decreased over the past decade.
• Rising healthcare expenses necessitate revenue adjustments by hospitals, potentially increasing service charges.
• This can disproportionately impact underinsured patients.

Purpose of the Study:

• To analyze Medicare billing and utilization trends for common vascular surgical procedures.
• To characterize changes in charges, reimbursements, and charge-to-reimbursement ratios.
• To investigate trends across different care settings (facility vs. non-facility).

Main Methods:

• Utilized the 2017-2021 Medicare Physician and Other Practitioners by Provider and Service dataset.
• Queried Current Procedural Terminology (CPT) codes for common vascular surgery procedures.
• Calculated average charges, reimbursements, charge-to-reimbursement ratios, and service counts, adjusting for inflation.

Main Results:

• Facility charges increased by 6.6% ($3708 to $3952) from 2017-2021, with charge-to-reimbursement ratios rising from 7.2 to 8.6.
• Reimbursements for 17 of 19 facility procedures declined by 10.4% on average.
• Non-facility charges and reimbursements both decreased, while procedural utilization remained stable, with notable increases in atherectomy procedures.

Conclusions:

• Vascular surgery billed to Medicare Part B shows increased facility charges and decreased reimbursements, widening the charge-to-reimbursement gap.
• Non-facility settings experienced decreased charges and reimbursements.
• Increased charges in facility settings may hinder access to care for underinsured patients.