美国外科实践:医疗保险程序和退款的23年趋势
Rohin Singh1, Ataollah Shahbandi1, Aman Singh1
1Department of Neurosurgery, University of Rochester, Rochester, NY.
Annals of surgery
|August 13, 2025
概括
尽管COVID-19流行病下降,但外科手术手术量从2000年至2022年增加,但所有专业的通货膨胀调整后补偿率下降. 大多数当前程序术语 (CPT®) 代码的价值随着时间的推移而下降.
科学领域:
- 卫生经济学 卫生经济学
- 外科手术的结果
- 医疗保健政策 医疗保健政策
背景情况:
- 了解影响外科实践的财务趋势对于患者获得护理至关重要.
- 手术报销和使用模式是实践可行性的关键指标.
- 医疗保险人口代表了外科手术分析的重要人口统计.
研究的目的:
- 描述医疗保险人口 (2000-2022) 中顶级外科手术程序的程序利用情况.
- 在研究期间量化这些程序的报销率的趋势.
- 分析基于医疗保险补偿的外科专业的财务可持续性.
主要方法:
- 利用国家外科质量改进计划 (NSQIP) 来识别顶级的当前手术术语 (CPT®) 代码.
- 分析的医疗保险B部分国家总结 程序数量和退款率 (2000-2022) 的文件数据.
- 将所有退款率调整为通胀至2022年,并使用线性回归来评估趋势.
主要成果:
- 在11个外科专业分析了超过5300万次手术和580亿美元的退款.
- 整形外科手术在手术量 (17.3M) 中领先,而整形 ($ 22.4B),心脏 ($ 7.2B) 和神经外科 ($ 6.7B) 的报销最高.
- 所有专业都经历了通货膨胀调整后偿还率的下降,血管外科 (-43.05%) 和神经外科 (-21.06%) 分别出现最大和最小的下降.
结论:
- 从2000年到2022年,外科手术的数量普遍增加,与流行病相关的显著下降和随后的恢复有关.
- 在大多数外科专业和CPT®代码中,每次手术的通货膨胀调整后的报销率一直在下降.
- 这些发现凸显了外科手术实践面临的重大财务压力,可能会影响未来患者获得护理的机会.
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