Neurosurgery Medicare Payments Down 11% Over 19 Years

LOS ANGELES — Though neurosurgeons remain the most highly paid physicians in the United States, a new study finds that the Medicare reimbursement rates for the 20 most common neurosurgery procedures fell by an inflation-adjusted 11.2% from 2002 to 2021.

The largest percentage change came in reimbursements for the excision of a cerebellopontine angle tumor via removal of skull bone (CPT code 61526).

Those payments fell by whopping 24.3% when adjusted for inflation to $3442 in 2021, researchers reported April 21 at the American Association of Neurological Surgeons (AANS) 2023 annual meeting here.

Explanations for the overall reductions include efforts to balance the national budget by cutting Medicare spending, although Congress ultimately repealed plans for double-digit percentage cuts more starting in 2010, said lead study author Reed A. Richter, a medical student at McGovern Medical School at UTHealth Houston, in an interview.

“It is important that these trends are understood and considered by surgeons, healthcare administrators, and policymakers,” he said.

Richter and colleagues analyzed data from the Centers for Medicare & Medicaid Services and the National Surgical Quality Improvement Program (American College of Surgeons). They found that the average reimbursement rates for the procedures in 2021 ranged from $903 to $3835; in 2002, the rates — not retroactively adjusted for inflation — ranged from $545 to $3486.

Inflation-adjusted reimbursements only rose for two procedures: removal of a part of the skull to reduce intracranial pressure (CPT code 61322), up 0.75%, and removal of the temporal bone through an elevated portion of skull bone when testing the temporal lobe for epileptic seizures (CPT code 61537), up 8.1%.

Several strategies “have been discussed to potentially stabilize reimbursement within neurosurgery,” Richter said in his AANS presentation. “These include payment models such as bundled payments and accountable care organizations. However, despite interest, there has been notable difficulty properly risk-adjusting patients under these potential models as well as difficulty defining standardized and attainable outcomes.”

Researchers have identified similar trends in Medicare reimbursements for other medical specialties and for physicians as a whole. The American Medical Association reported that overall Medicare physician reimbursements fell by an inflation-adjusted 22% from 2001 to 2021.

In an interview, Vanderbilt University health economist Melinda J. B. Buntin, PhD, said that the reductions in Medicare reimbursement are due to years of efforts to rein in spending after the agency “decided the amount of money being spent was just growing faster than the economy as a whole.”

Private insurers are influenced by Medicare reimbursement levels, she said, although their payment rates are typically higher.

At the same time, she said, physicians are now providing more reimbursed services overall than in the past, which boosts their payments. And, she added, “just because a payment doesn’t go up doesn’t mean it’s not profitable.”

As for neurosurgery specifically, she said that it’s generally “not considered to be a low-income or a loss center for hospitals. These numbers should be seen in that context.”

Like many other medical organizations, AANS lobbies national leaders for higher Medicare reimbursement levels. As Medscape Medical News reported in December 2022, “Congress averted bigger reductions in Medicare’s future payments for clinicians in its massive, year-end spending bill, but physicians will still see a 2% cut in a key payment variable in 2023.” The move averted an expected 6.5% cut in Medicare payments.

There is no study funding. The study authors and Buntin report no disclosures.

American Association of Neurological Surgeons (AANS) 2023 Annual Meeting. Presented April 21, 2023.

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