Download PDF
J Reconstr Microsurg 2024; 40(06): 416-422
DOI: 10.1055/a-2199-4226
Original Article

Billing and Utilization Trends in Reconstructive Microsurgery Indicate Worsening Access to Care

Daniel J. Koh
1   Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
2   Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
,
Jung Ho Gong 
1   Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Nikhil Sobti
1   Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Raman Mehrzad
1   Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Dardan Beqiri
1   Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Sophia Ahn
1   Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Amy Maselli
1   Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Daniel Kwan
1   Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Within the last 20-years, Medicare reimbursements for microsurgery have been declining, while physician expenses continue to increase. As a result, hospitals may increase charges to offset revenue losses, which may impose a financial barrier to care. This study aimed to characterize the billing trends in microsurgery and their implications on patient care.

Methods The 2013 to 2020 Provider Utilization and Payment Data Physician and Other Practitioners Dataset was queried for 16 CPT codes. Service counts, hospital charges, and reimbursements were collected. The utilization, weighted mean reimbursements and charges, and charge-to-reimbursement ratios (CRRs) were calculated. The total and annual percent changes were also determined.

Results In total, 13 CPT codes (81.3%) were included. The overall number of procedures decreased by 15.0%. The average reimbursement of all microsurgical procedures increased from $618 to $722 (16.7%). The mean charge increased from $3,200 to $4,340 (35.6%). As charges had a greater increase than reimbursement rates, the CRR increased by 15.4%. At the categorical level, all groups had increases in CRRs, except for bone graft (−49.4%) and other procedures (−3.5%). The CRR for free flap breast procedures had the largest percent increase (47.1%). Additionally, lymphangiotomy (28.6%) had the second largest increases.

Conclusion Our analysis of microsurgical procedures billed to Medicare Part B from 2013 to 2020 showed that hospital charges are increasing at a faster rate than reimbursements. This may be in part due to increasing physician expenses, cost of advanced technology in microsurgical procedures, and inadequate reimbursement rates. Regardless, these increased markups may limit patients who are economically disadvantaged from accessing care. Policy makers should consider legislation aimed at updating Medicare reimbursement rates to reflect the increasing complexity and cost associated with microsurgical procedures, as well as regulating charge markups at the hospital level.

Keywords

microsurgery - Medicare - reimbursement - charges - markup - plastic surgery

Author Contributions

D.K. was responsible for conceptualization, methodology, and writing—original draft. J.H.G. was responsible for conceptualization, methodology, and formal analysis. N.S. was responsible for conceptualization, methodology, and writing—original draft. R.H. was responsible for conceptualization, writing—original draft. D.B. was responsible for conceptualization, methodology, and writing—review and editing. S.A. was responsible for formal analysis and writing—review and editing. A.M. was responsible for conceptualization, methodology, and writing—review and editing. D.K. was responsible for conceptualization, methodology, and writing—review and editing.


Supplementary Material



Publication History

Received: 11 August 2023

Accepted: 13 October 2023

Accepted Manuscript online:
26 October 2023

Article published online:
18 December 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA