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New England Section of the American Urological Association

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Trending Medicare Reimbursement in Urological Surgery: 2000-2020
Benjamin Pockros, BA, Daniel Finch, BA, Caroline Liang, BA, David Canes, MD.
Tufts University School of Medicine, Boston, MA, USA.

Background: A historical perspective of Urology reimbursement is important to inform and guide future payment policy in Urology. Physician reimbursement in the United States is largely determined by Medicare as the single largest and most dominant healthcare payer. The Medicare population is projected to increase by over 40% in the next decade. Analyzing reimbursement trends may help Urology practices prepare for upcoming financial changes. This study critically evaluates fiscal trends in Medicare reimbursement rates in Urological surgery over a 20-year period.
Methods:The 20 most commonly billed Current Procedural Terminology (CPT) codes in Urology were queried using the American College of Surgeonís National Surgical Quality Improvement Project (NSQIP) database. Reimbursement data from 2000 to 2020 was collected for each CPT code using the Center for Medicare Services Physician Fee Schedule Look-Up Tool. Relative Value Units (RVUs) were collected for each procedure. The change in annual reimbursement rates from 2000 to 2020 were compared with percent change in consumer price index (CPI) over the same period using a 2-tailed t test. CPI is a measure of inflation and was used to adjust all reimbursement data to 2020 US dollars. A subgroup analysis was performed to compare the average adjusted reimbursement changes across different surgical categories, including oncologic vs nononcologic procedures.
Results: Between 2000 and 2020, the mean unadjusted reimbursement rate for all included procedures decreased by 5.6% between 2000 and 2020 while the CPI increased by 50.32% over the same period. When adjusted to 2020 US dollars, the mean reimbursement for the fourteen urologic oncology procedures decreased by 35.8% (Figure 1). The average annual change in reimbursement reflected by CAGR was -2.3%, indicating a steady annual decline. Compared with the annual percent change in CPI between 2000 and 2020 (2.1%), the CAGR was significantly lower (p<0.0001). The largest adjusted reimbursement decrease (57%) was for cystoscopy with bladder fulguration. The smallest adjusted decrease (18%) was for laparoscopic partial nephrectomy.
Conclusions: This study demonstrates that on average, Medicare physician reimbursement rates for the 20 most common Urological surgical procedures * by *% from 2000 to 2020 when adjusting for inflation. Contextualizing these changes in reimbursement is critical, given that inflation has increased by 53% over the same 20-year period and that practice expenses continue to increase. The findings of this study may be important for Urologists to consider during critical health policy decisions in the US. Urologists, policy leaders, and hospital committees should consider these trends when developing new payment models.


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