State Variation in Medicare Reimbursement for the Top 100 Cardiothoracic Surgery Procedures, 2013-2022

Area of Science:

• Cardiovascular Surgery
• Health Economics
• Public Health Policy

Background:

• Medicare reimbursement rates are crucial for surgical practice viability.
• Understanding trends in reimbursement is essential for healthcare policy and physician distribution.
• Cardiothoracic surgery reimbursement has faced scrutiny due to evolving healthcare costs and policies.

Purpose of the Study:

• To analyze changes in Medicare reimbursement rates for cardiothoracic surgery procedures from 2013 to 2022.
• To identify interstate variations in reimbursement trends.
• To compare reimbursement changes across different cardiothoracic procedural groups.

Main Methods:

• Analysis of the Centers for Medicare and Medicaid Services database for top-grossing cardiothoracic surgery CPT codes (2013-2022).
• Utilization of Medicare Administrative Contractor codes to determine state-specific reimbursement.
• Inflation adjustment of payments using the Consumer Price Index and revenue-based weighting of procedures.

Main Results:

• A nationwide average annual decrease of 2.67% in inflation-adjusted Medicare reimbursement for top cardiothoracic procedures.
• Smallest reimbursement changes observed in Puerto Rico, Louisiana, and Alabama; largest decreases in Illinois, Kansas, and Wyoming.
• Significant differences in reimbursement changes noted between pacemaker/defibrillator procedures and valvular/coronary artery bypass graft (CABG) surgery.

Conclusions:

• Reimbursement patterns for cardiothoracic surgery exhibit significant geographical variation across U.S. states.
• Geographic disparities in Medicare reimbursement may influence physician practice location decisions.
• Targeted lobbying strategies may be necessary to address declining reimbursement and ensure quality care for Medicare beneficiaries.