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Regional Variations in Elective Hand Surgery Performed by Hand Surgeons in the Medicare Population
Michael P. Gaspar, MD; Patrick M. Kane, MD; Sidney M. Jacoby, MD; Eon K. Shin, MD; A. Lee Osterman, MD
Philadelphia Hand Center, Philadelphia, PA

Introduction: In this study, we aim to investigate the role that geographic region of practice has on hand surgeons' performance of elective hand surgery. We hypothesize that a significant variation in Medicare reimbursement exists among hand surgeons for commonly performed elective hand surgeries based on their primary geographic region of practice.
Methods: Using data from the American Society for Surgery of the Hand (ASSH), we identified all surgeons with active membership in the ASSH 2012. ASSH members' identifying data was matched with provider information from the Medicare database as produced by the United States Centers for Medicare and Medicaid Services (CMS). Members with inconsistent data between the two databases were excluded. Surgeons' primary state of practice was used for allocation to one of the ten established CMS regions. Raw data was analyzed to determine the most common surgeries performed across all ASSH members. Linear regression analysis was performed using data from each surgery of interest performed per region in conjunction with the 2012 Unites States census data. This was used to determine correlations between each region's total population, number of ASSH members, number of surgeries performed and CMS reimbursement. Average reimbursements were compared between geographic regions using ANOVA analysis for each surgery of interest.
Results: A total of 1,686 ASSH members satisfied inclusion in this study. The five most commonly coded surgical procedures across all ASSH members are outlined in Table I. There was significant variation in total CMS reimbursement per surgeon when compared geographically using ANOVA, as outlined in Table II. There was statistically significant negative correlation between the average reimbursement per surgery performed and the number of ASSH member surgeons per region and (R-sq = 26.9%, p < 0.0001) as well between the average reimbursement per surgery and the number of total cases performed per region (R-sq = 29.0%, p = 0.0). However, there was no significant correlation between the average reimbursement in a given region and that region's total population, or its population of Medicare beneficiaries.
Conclusions: Significant geographic variation exists among ASSH members with regards to CMS reimbursement for commonly performed hand surgeries. This variation does not appear to be influenced by population demands but rather due to supply of hand surgeons in a given region. This information may be especially useful for hand surgeons looking to optimize reimbursement and/or those who expect to treat a significant proportion of Medicare patients in their own practice. I. TABLES


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