Hand Surgery Billing and Utilization Trends Indicate Worsening Barriers to Accessing Care
Jung Ho Gong, AB1, Chao Long, MD, MPH2,3, Adam E. M. Eltorai, MD, PhD4, Kavya K Sanghavi, MPH5 and Aviram M. Giladi, MD, MS5, (1)Warren Alpert Medical School of Brown University, Providence, RI, (2)Johns Hopkins Medicine, Baltimore, CA, (3)The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, (4)Brigham and Women's Hospital, Boston, MA, (5)Curtis National Hand Center, Baltimore, MD
Introduction: Hospitals and providers are increasing charges to compensate for lost revenue from decreasing reimbursement. Increasing charges, combined with a shift to ambulatory surgical centers (ASCs), may threaten the accessibility of affordable care for uninsured and underinsured patients. We aimed to analyze hand surgery procedures across different service settings and areas to characterize utilization and billing trends in the hand patient population.
Materials and Methods: We queried the Physician/Supplier Procedure Summary for hand surgery procedures consistently billed to Medicare Part B from 2010 to 2019. We collected the number of procedures performed, charges, and reimbursements. We adjusted procedural volume by Medicare enrollment and adjusted all monetary values to the 2019 US dollar to account for inflation. We calculated the weighted means of charges and reimbursement for each year and calculated reimbursement-to-charge ratios (RCRs). We calculated overall change and r2 from 2010 to 2019 for all procedures. To better understand trends, we stratified by procedural type, service setting, and state where service was performed.
Results: Weighted mean charges, reimbursement, and RCRs changed by +21.0% (from $1,227 to $1,485; r2 0.93), +10.8% (from $321 to $356; r2 0.69), and -8.4% (from 0.26 to 0.24; r2 0.76), respectively (Figure 1). The Medicare enrollment-adjusted number of procedures performed in ASCs increased by 63.8% (r2 0.95) while those performed in inpatient settings decreased by 39.0% (r2 0.89) (Figure 2). Trends in utilization and billing varied widely across different procedural types, service settings, and states.
Conclusions: Our nationwide Medicare claims study demonstrated that charges for hand surgery procedures steadily increased by more than 20% in recent years, possibly reflecting an attempt to make up for reimbursements perceived to be inadequate. This trend places uninsured and underinsured hand patients at greater risk for financial catastrophe, as they may be responsible for full or partial charges. Over the same period, procedures shifted from the inpatient to the ASC setting. This shift may further limit access to affordable hand care for our uninsured or underinsured patients.
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