Medicare Facility Diagnosis Related Groups Have Outpaced Individual Physician Payment
Department of Pediatrics, Division of Emergency Medicine
Health Services Administration | Surgery
INTRODUCTION: We set out to compare the rates of Medicare reimbursement to physicians versus hospitals for several major vascular procedures over a period of five years.
METHODS: We queried the Wolters Luwer MediRegs database to collect Medicare reimbursement data from fiscal years 2011 to 2015. We surveyed reimbursements for carotid endarterectomy (CEA), carotid angioplasty and stenting (CAS), femoropopliteal bypass, and lower extremity fem-pop revascularization with stenting. Based on data availability, we surveyed physician reimbursement data on the national level and in both medically over-served and underserved areas. Hospital reimbursement rates were examined on a national level and by hospitals' teaching and wage index statuses.
RESULTS: We found that for all four vascular procedures, Medicare reimbursements to hospitals increased by a greater percentage than to physicians. By region, underserved areas had lower physician reimbursements than the national average, while the opposite was true for overserved areas. Additionally, for hospital Medicare reimbursements, location in a high wage index accounted for a significant increase in reimbursement over the national average, with teaching status contributing to this increase to a smaller extent.
CONCLUSIONS: This data on Medicare reimbursements indicate that payments to hospitals are increasing more significantly than to physicians. This disparity in pay changes affects both independent and academic vascular surgeons. Medicare should consider pay increases to independent providers in accordance to the hospital pay increase.
DOI of Published Version
Ann Vasc Surg. 2016 Aug 20. pii: S0890-5096(16)30673-2. doi: 10.1016/j.avsg.2016.05.133. [Epub ahead of print] Link to article on publisher's site
Annals of vascular surgery
Zhu CK, Eslami PW, Eslami MH. (2016). Medicare Facility Diagnosis Related Groups Have Outpaced Individual Physician Payment. Pediatric Publications. https://doi.org/10.1016/j.avsg.2016.05.133. Retrieved from https://escholarship.umassmed.edu/peds_pp/98