目标:在过去的十年中,各种外科手术的MedicareB部分报销一直在下降,医疗费用继续增加。因此,医院可能会增加服务费以抵消收入损失,这可能会不成比例地影响保险不足的患者。我们的分析旨在描述常见血管外科手术中的医疗保险账单和利用趋势。
方法:按提供者和服务数据集查询了2017-2021年Medicare医师和其他从业人员常见血管外科手术的CPT代码。平均费用,报销,收费与报销比率,计算血管外科医师进行的最常见干预的服务计数.数据按护理环境分层,设施(住院和门诊医院)与非设施地点。所有货币价值均调整为2021年美元,以计入通货膨胀。
结果:对于设施设置,从2017年到2021年,向MedicareB部分收取的平均费用从3,708美元增加到3,952美元(6.6%),平均费用与报销比率从7.2增加到8.6。19个设施程序中有17个偿还额下降,从平均558美元降至499美元(-10.4%)。穿刺静脉切除术在设施报销方面有最大的个人下降(-53.5%),其次是膝盖以上截肢(-11.3%)和膝盖以下截肢(-11.0%)。在研究期间,非设施费用(-10.8%)和报销(-12.2%)都有所下降。2017年至2019年,程序利用率保持稳定。胫骨和股-pop动脉粥样斑块切除术分别增加了45.9%和33.7%,分别,从2017年到2019年在非设施环境中执行的总体程序利用率结论:我们对2017年到2021年向MedicareB部分收费的血管手术程序的分析显示费用增加,报销的减少,以及随之而来的设施护理设置的收费与报销比率的增加。相比之下,面对偿还额下降的情况,非设施费用有所下降。在设施位置提交的费用中的这些加价可能会成为获得保险不足的患者的额外障碍。
OBJECTIVE: Within the past decade, Medicare Part B reimbursements for various surgical procedures have been declining, whereas health care expenses continue to increase. As a result, hospitals may increase service charges to offset losses in revenue, which may disproportionately affect underinsured patients. Our analysis aimed to characterize Medicare billing and utilization trends across common vascular surgical procedures.
METHODS: The 2017 to 2021 Medicare Physician and Other Practitioners by Provider and Service dataset was queried for Current Procedural Terminology (CPT) codes for common vascular surgery procedures. The average charges, reimbursements,
charge-to-reimbursement ratios, and service counts were calculated for the most common interventions performed by vascular surgeons. Data was stratified by care setting, facility (inpatient and outpatient hospital) vs non-facility locations. All monetary values were adjusted to the 2021 United States dollars to account for inflation.
RESULTS: For facility settings, the mean
charge billed to Medicare Part B increased from $3708 to $3952 (6.6%) from 2017 to 2021, with the average
charge-to-reimbursement ratio increasing from 7.2 to 8.6. There were 17 of the 19 facility procedures that had a decline in reimbursements, decreasing from an average of $558 to $499 (-10.4%). Stab phlebectomy had the largest individual decrease in facility reimbursement (-53.5%), followed by above-knee amputation (-11.3%) and below-knee amputation (-11.0%). Both non-facility charges (-10.8%) and reimbursements (-12.2%) declined over the study period. Procedural utilization remained stable from 2017 to 2019. Tibial and femoral-popliteal atherectomy had increases of 45.9% and 33.7%, respectively, in overall procedural utilization when performed in non-facility settings from 2017 to 2019.
CONCLUSIONS: Our analysis of vascular surgery procedures billed to Medicare Part B from 2017 to 2021 demonstrates an increase in charges, a decline in reimbursements, and a resultant increase in
charge-to-reimbursement ratios for facility care settings. In contrast, non-facility charges have decreased in the face of declining reimbursements. These markups in submitted charges in facility locations may serve as an additional barrier to accessing care for patients who are underinsured.