SS16 - Medicare Utilization and Billing Trends for Vascular Surgery Procedures

Objectives: Within the last decade, Medicare reimbursements for various surgical procedures have been declining, while healthcare expenses continue to increase. As a result, hospitals may increase service charges to offset losses in revenue, which may disproportionately affect underinsured patients. Our analysis aimed to characterize the utilization and Medicare billing trends among common vascular surgical procedures.

Methods: The 2017-2021 Medicare Physician and Other Practitioners by Provider and Service dataset was queried for CPT codes. The utilization, mean reimbursements and charges, and charge-to-reimbursement ratios (CRRs) were calculated for the most common interventions performed by a vascular surgeon. Procedural utilization included data from both facility (inpatient and outpatient hospital settings) and non-facility care settings. Non-facility data was excluded from analysis of billing trends due to differences in reimbursement modality. All monetary values were adjusted to the 2021 US dollars to account for inflation.

Results: Overall procedural utilization decreased by 16.4% from 2017 to 2021 (Figure 1). Venous stenting and tibial atherectomy were the only procedures that had a rise in utilization, increasing by 5.4% and 18.5%, respectively. Tibial (+45.9%) and femoral-popliteal (+33.7%) atherectomy, tibial percutaneous transluminal angioplasty (PTA) (+31.9%), and venous stenting (+25.1%) had large increases in non-facility utilization. With regard to billing trends, the average charge billed to Medicare Part B increased from $3,708 to $3,952 (6.6%). Femoral-popliteal (+19.3%) and tibial (+18.9%) atherectomy had the largest increases in charges. In terms of reimbursements, 17 out of the 19 procedures had a decline in reimbursements, with the average decreasing from $558 to $499 (-10.4%). Stab phlebectomy had the largest individual decrease in reimbursement (-53.5%), followed by above knee amputation (-11.3%), below knee amputation (-11.0%), and carotid endarterectomy (-10.6%). Overall, the average charge-to-reimbursement ratio increased from 7.2 to 8.6 over the study period, with stab phlebectomy (+113.4%), femoral-popliteal stent (+26.7%), and iliac PTA (+24.5%) having the largest individual increases.

Conclusions: Our analysis of Vascular Surgery procedures billed to Medicare Part B from 2017 to 2021 shows a decline in reimbursements, an increase in procedural charges, and a resultant increase in markup ratios. This is a concerning trend, as increasing procedural charges may serve as a barrier to accessing care for patients who are underinsured or uninsured. Further investigation into these billing trends should be prioritized, as they will better position surgeons to advocate for improvements in access to care.