دورية أكاديمية
Medical center reimbursement for vascular procedures has increased over time while professional reimbursement has declined.
| العنوان: | Medical center reimbursement for vascular procedures has increased over time while professional reimbursement has declined. |
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| المؤلفون: | Fang ZB; Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA., Schanzer A; Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA., Judelson DR; Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA., Jones DW; Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA., Simons JP; Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA., Sheaffer W; Division of Vascular and Endovascular Surgery, Mayo Clinic Arizona, Phoenix, AZ., Meltzer AJ; Division of Vascular and Endovascular Surgery, Mayo Clinic Arizona, Phoenix, AZ., Aiello FA; Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA. Electronic address: francesco.aiello@umassmemorial.org. |
| المصدر: | Journal of vascular surgery [J Vasc Surg] 2023 Feb; Vol. 77 (2), pp. 616-622. Date of Electronic Publication: 2022 Oct 27. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 8407742 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6809 (Electronic) Linking ISSN: 07415214 NLM ISO Abbreviation: J Vasc Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2008-> : New York, NY : Elsevier Original Publication: St. Louis, Mo. : Mosby, [c1984- |
| مواضيع طبية MeSH: | Physicians* , Endarterectomy, Carotid*, Aged ; Humans ; United States ; Medicare ; Vascular Surgical Procedures ; Angioplasty ; Insurance, Health, Reimbursement |
| مستخلص: | Objective: The United States healthcare system uses different methods for assigning medical center reimbursement (MCR) and professional reimbursement (PR) for clinical services. We hypothesized that PR has not increased proportionately to MCR for the same vascular services. Methods: MCR and PR were compared for commonly performed inpatient and outpatient vascular procedures between 2012 and 2021. MCR was calculated using the Medicare inpatient prospective payment system and outpatient prospective payment system. MCR is based on the Centers for Medicare and Medicaid Services definition and criteria for comorbidities and the occurrence of complications; thus, changes in MCR were reported as a range based on the degree of comorbidities and complications using the Diagnosis Related Group. PR was calculated using the Medicare physician fee schedule, which assigns a numerical work relative value unit to each surgical service, with final compensation determined by an annually adjusted conversion factor to yield a final dollar amount. The expected reimbursement based on the observed inflation during the study period using the consumer price index was calculated and compared to the actual reimbursement. Results: From 2012 to 2021, MCR for inpatient procedures increased 20% to 26% for carotid endarterectomy, 24% to 27% for femoral endarterectomy, 24% to 27% for femoropopliteal bypass with vein, 14% to 19% for thoracic endovascular aortic repair, and 15% for aortobifemoral bypass. During the same period, PR increased 3.3% for carotid endarterectomy but decreased for femoral endarterectomy (-5.0%), femoropopliteal bypass (-4.6%), thoracic endovascular aortic repair (-4.2%), and aortobifemoral bypass (-5.0%). Comparing the expected reimbursement, adjusted for inflation, to the actual reimbursement, PR experienced a 10% to 17% reduction but MCR outpaced inflation by 3.7% to 10%. For outpatient procedures, MCR increased 117% for tibial angioplasty, 24% for superficial femoral artery (SFA) stenting, 62% for tunneled dialysis catheter (TDC) insertion, and 24% for iliac stenting but decreased 0.43% for arteriovenous fistula (AVF) creation and 7.6% for radiofrequency ablation (RFA). PR increased 0.91% for SFA stenting but decreased for tibial angioplasty (-17%), AVF creation (-6.4%), TDC insertion (-7.1%), iliac stenting (-3.8%), and RFA (-22%). Comparing the expected reimbursement, adjusted for inflation, to the actual reimbursement, PR experienced a 13% to 32% reduction. In contrast, MCR outpaced inflation 7.5% to 88% for tibial angioplasty, SFA stenting, TDC insertion, and iliac stenting but experienced a reduction for AVF (-13%) and RFA (-19%). Conclusions: MCR for commonly performed vascular procedures has increased and outpaced inflation. In contrast, PR for these same services has decreased across all procedure types. This decrease in PR was exacerbated when adjusted for inflation. This inequity in the reimbursement methods between MCR and PR poses a threat to the viability of the physician workforce. Either changes to the reimbursement methods or a reallocation of reimbursement to physicians are imperative to sustain physician practices. (Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.) |
| التعليقات: | Comment in: J Vasc Surg. 2023 Feb;77(2):623-624. (PMID: 36681485) |
| فهرسة مساهمة: | Keywords: Inflation; Medical center reimbursement; Professional reimbursement |
| تواريخ الأحداث: | Date Created: 20221029 Date Completed: 20230124 Latest Revision: 20231124 |
| رمز التحديث: | 20231124 |
| DOI: | 10.1016/j.jvs.2022.10.023 |
| PMID: | 36309320 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1097-6809 |
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| DOI: | 10.1016/j.jvs.2022.10.023 |