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COVID-19-associated trends in Medicare utilization for plastic and reconstructive surgery
Jason Zhang1, Anitesh Bajaj1, Nikhil Sriram1
1Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, United States.
Purpose:
The Medicare population is a subset of plastic surgery patients with unique needs and characteristics. Studies before COVID-19 have shown decreasing reimbursements and increasing charges. We aimed to characterize changes in Medicare reimbursements and charges in plastic and reconstructive (PR) surgery since the pandemic.
Methods:
The CMS Medicare Physician & Other Practitioners database was used to analyze all procedural codes billed by PR surgeons from 2013 to 2023. Subgroup analysis was conducted based on the organ system (integumentary, musculoskeletal, nervous, and other). Primary outcomes were the total number of services billed, average Medicare standardized payment, average submitted charge, and average percent reimbursed per visit. An interrupted time series analysis (ITSA) was conducted with the break point set in 2020. All dollar amounts were inflation-adjusted to 2023.
Results:
A total of 4,903,961 services for 2,970,140 beneficiaries were billed to Medicare by 3767 surgeons. Between 2013 and 2023, there were decreases in volume (-31.9%), average Medicare standardized payment (-39.9%), average non-Medicare payment (-33.7%), percent reimbursed (-10.9%), and charge (-12.8%). ITSA revealed a significant drop in volume in 2020 (p < 0.001) and significant changes in slope after 2020 in Medicare payments (p = 0.009) and average charge (p = 0.001).
Conclusions:
Exacerbated by the COVID pandemic, the downward trends in Medicare utilization and reimbursements for PR surgery have made it more challenging for surgeons serving Medicare recipients. Acknowledging these trends is vital to prevent increased care barriers to PR surgery and ensure better health for Medicare patients.
