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Medicare Billing Trends in Vascular Surgery
Daniel J. Koh, B.A.
1, Mohammad H. Eslami, M.D., M.P.H., M.B.A
2, Eric Sung, B.A.
1, Hojoon H. Seo, B.A.
1, Brenda Lin, M.D.
1, Alex Lin, M.D.
1, Thomas W. Cheng, M.D.
3, Andrea Alonso, M.D.
1, Elizabeth King, M.D.
1, Alik Farber M.D., M.B.A.
1, Jeffrey J. Siracuse M.D., M.B.A.
1
1Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 2Department of Vascular Surgery, CAMC Institute for Academic Medicine, Charleston, WV, 3Divison of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, NH
Background: Within the last decade, Medicare Part B reimbursements for surgical procedures have been declining, while healthcare expenses continue to increase. As a result, hospitals may increase charges to offset losses in revenue. Our analysis aimed to characterize Medicare billing trends in Vascular Surgery.
Methods: The 2017-2021 Medicare Physician and Other Practitioners dataset was queried for CPT codes for common Vascular Surgery procedures. The average charges, reimbursements, and charge-to-reimbursement ratios were calculated. Data was stratified by location, facility (inpatient and outpatient hospital) versus non-facility locations. All monetary values were adjusted to the 2021 US dollar.
Results: For facility settings, the mean charge increased from $3,708 to $3,952 (6.6%), with the average charge-to-reimbursement ratio increasing from 7.2 to 8.6. There were 17 out 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.
Conclusion: 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.
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