Introduction:
Medicare is a significant insurer for patients seeking urological surgeries. As a proxy, the median age at diagnosis of prostate cancer is 67, bladder cancer is 73, and kidney cancer is 64. The volume of surgeries reimbursed by Medicare will continue to grow as the Medicare population is projected to increase by over 22% in the next decade. Analyzing recent reimbursement trends may help urology practices contextualize payment policy and prepare for upcoming financial changes. The purpose of this study was to evaluate the fiscal trends in Medicare reimbursement of urologic oncology surgeries over the last two decades.
Methods:
The American College of Surgeon’s National Surgical Quality Improvement Project (NSQIP) database was queried for the twenty most common Current Procedural Terminology (CPT) urologic procedures by volume. Fourteen of the procedures were oncological. Reimbursement data from 2000 to 2020 was collected for each CPT code using the Center for Medicare Services Physician Fee Schedule Look-Up Tool. To compare annual rates of change, the compound annual growth rate (CAGR) between 2000-2020 was calculated for each CPT code. CAGR can help mitigate volatility when calculating annual growth rates. The CAGR in reimbursement rates from 2000 to 2020 were compared with the annual percent change in consumer price index (CPI) over the same period using a 2-tailed t test. CPI is a measure of inflation and was used to adjust all reimbursement data to 2020 US dollars.
Results:
Between 2000 and 2020, the mean unadjusted reimbursement rate for all included procedures decreased by 5.6% between 2000 and 2020 while the CPI increased by 50.32% over the same period. When adjusted to 2020 US dollars, the mean reimbursement for the fourteen urologic oncology procedures decreased by 35.1% (Figure 1). The average annual change in reimbursement reflected by CAGR was -2.3%, indicating a steady annual decline. Average RVUs for the included surgeries increased by 3.5%.
Conclusion:
Medicare physician reimbursement rates for the fourteen most common urologic oncology surgeries decreased by 35.1% from 2000 to 2020 when adjusting for inflation. Interestingly, RVUs over the same study period increased by 3.5%, implying alternative factors are in effect. Health policy legislators must cautiously navigate strategies to reduce health care costs, such as limiting Medicare reimbursement, and consider potential consequences, such as financial vulnerability for medical practices and subsequent reduction in patient access to care.
Funding: N/A
Image(s) (click to enlarge):
TRENDING MEDICARE REIMBURSEMENT OF THE MOST COMMON UROLOGIC ONCOLOGY SURGERIES BETWEEN 2000-2020
Category
Health Services
Description
Poster #182
Friday, Dec 3
11:00 a.m. 12:00 p.m.
Health Services
Presented By: Benjamin Pockros
Authors:
Benjamin Pockros
Daniel Finch
Caroline Liang
David Canes