Trends in Medicare reimbursement for neurosurgical procedures: 2000 to 2018

Abstract

Objective: There is currently a paucity of literature evaluating procedural reimbursements and financial trends in neurosurgery. A comprehensive understanding of the economic trends and financial health of neurosurgery is important to ensure the sustained success and growth of the specialty moving forward. The purpose of this study was to evaluate monetary trends of the 10 most common spinal and cranial neurosurgical procedures in Medicare reimbursement rates from 2000 to 2018.

Methods: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for each of the top 10 most utilized Current Procedural Terminology codes in both spinal and cranial neurosurgery, and comprehensive reimbursement data were extracted. The raw percent change in Medicare reimbursement rate from 2000 to 2018 was calculated for each procedure and averaged. This was then compared to the percent change in consumer price index over the same time. Using data adjusted for inflation, trend analysis was performed for all included procedures. Adjusted R-squared and both the average annual and the total percent change in reimbursement were calculated based on these adjusted trends for all included procedures. Likewise, the compound annual growth rate was calculated for all procedures.

Results: When all reimbursement data were adjusted for inflation, the average reimbursement for all procedures decreased by an average of 25.80% from 2000 to 2018. From 2000 to 2018, the adjusted reimbursement rate for all included procedures decreased by an average of 1.59% each year and experienced an average compound annual growth rate of -1.66%, indicating a steady annual decline in reimbursement when adjusted for inflation.

Conclusions: This is the first study to evaluate comprehensive trends in Medicare reimbursement in neurosurgery. When adjusted for inflation, Medicare reimbursement for all included procedures has steadily decreased from 2000 to 2018, with similar rates of decline observed between cranial and spinal neurosurgery procedures. Increased awareness and consideration of these trends will be important moving forward for policy makers, hospitals, and neurosurgeons as continued progress is made to advance agreeable reimbursement models that allow for the sustained growth of neurosurgery in the United States.

Keywords: ACO = accountable care organization; CAGR = compound annual growth rate; CMS = Centers for Medicare & Medicaid Services; CPI = consumer price index; CPT = Current Procedural Terminology; DRG = diagnosis-related group; MACRA = Medicare Access and CHIP Reauthorization Act; Medicare; SGR = sustainable growth rate; finance; reimbursement.