Declining Trend in Medicare Physician Reimbursements for Hand Surgery From 2002 to 2018

Abstract

Purpose: To evaluate trends in Medicare physician reimbursements for 20 common hand procedures/surgeries from 2002 to 2018.

Methods: The Physician Fee Schedule Look-up Tool was used to retrieve average reimbursement rates for 20 common hand surgeries/procedures from 2002 to 2018. All reimbursement data were adjusted for inflation to 2018 dollars.

Results: After adjusting all data for inflation, the average reimbursement for all included procedures decreased by 20.9% from 2002 to 2018, with a compound annual growth rate of -3.25%. Reimbursement percentage decreases were the greatest prior to 2010 (18.4% decrease), followed by a relative stabilization (0.94% increase) from 2010 to 2014, after which physicians experienced a decrease of 3.9% in reimbursements between 2014 and 2018, following implementation of the Medicare Access and Children's Health Insurance Program Reauthorization Act in 2015. The most significant decreases in reimbursements over time were noted for primary tendon/muscle repair (-49.6%), wrist arthroscopy for triangular fibrocartilage repair/debridement (-44.0%), trigger finger release in facility (-40.1%), excision of extensor tendon sheath (-38.2%), ganglion cyst excision (-36.7%), wrist arthroscopy for diagnostic/synovial biopsy (-35.7%), wrist arthroscopy for drainage/infection/lavage (-35.1%), wrist arthrodesis (-30.6%), endoscopic carpal tunnel release (-27.2%), total wrist arthroplasty (-26.6%), carpometacarpal/basal joint arthroplasty (-25.1%), and open carpal tunnel release (-22.3%). The only procedures with a significant increase in reimbursement over time were trigger finger release in office (+4.2%), open reduction internal fixation distal radius fracture (+2.5%), and cubital tunnel release (+1.5%).

Conclusions: After adjusting for inflation, Medicare physician reimbursements for a major proportion of hand surgical procedures have decreased over time.

Clinical relevance: Health-policy makers need to understand the impact of decreasing reimbursements to develop policies of reimbursements that will not only ensure provider satisfaction but also maintain access to care for patients.

Keywords: Hand surgery; MACRA; Medicare physician fee; physician reimbursements; trends.