从 2013 年到 2020 年，医疗保险人群中的关节镜手术患者越来越多，而报销额度却在下降

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-08-01 DOI:10.1016/j.asmr.2024.100950

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引用次数: 0

摘要

目的评估医疗保险人群中不同风险特征患者的常见关节镜手术（包括关节镜下半月板剥除术和关节镜下肩袖修复术）的外科医生报销情况。方法使用公开的医疗保险数据库来识别 2013 年至 2020 年期间向医疗保险付费的所有关节镜下半月板剥除术和关节镜下肩袖修复术病例。我们收集了外科医生从医疗保险中报销的费用，并根据通货膨胀率进行了调整。所有手术事件被分为两组：分层条件类别（HCC）风险评分≥1.5的手术和患者HCC风险评分<1.5的手术。结果从 2013 年到 2020 年，共有 624,077 例半月板清创术和 567,794 例关节镜下肩袖修复术被纳入医疗保险 B 部分。在此期间，关节镜下肩袖修复术的调整后外科医生平均报销额从 2013 年到 2020 年下降了 9.2%。在同一时期，关节镜双腔半月板剥除术和单腔半月板剥除术的调整后外科医生平均报销额分别下降了 7.9% 和 9.9%。在整个研究期间，平均 HCC 风险评分从 2013 年的 1.19 上升到 2020 年的 1.31（P < .001）。在研究的所有年份中，病情较重的组群的所有合并症发生率明显更高，平均体重指数也更高（所有变量的 P < .001）。与健康人群相比，该人群的肩袖修复术（P = 0.037）和半月板剥离术（P <.001）的平均报销额度较低。结论本研究表明，从 2013 年到 2020 年，经通货膨胀调整后，关节镜肩袖修复术和半月板剥离术的外科医生报销额度有所下降，而患者的复杂性却有所增加。此外，复杂性更高的患者与更健康的患者相比，此类手术的外科医生平均报销额度更低。

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Arthroscopy Patients in Medicare Population Became Sicker While Reimbursement Decreased From 2013 to 2020

Purpose

To assess surgeon reimbursement for common arthroscopic procedures, including arthroscopic meniscal debridement and arthroscopic rotator cuff repair, in patients with differing risk profiles within the Medicare population.

Methods

A publicly available Medicare database was used to identify all cases of arthroscopic meniscal debridement and arthroscopic rotator cuff repair procedures billed to Medicare from 2013 to 2020. The surgeon reimbursement from Medicare was collected and adjusted for inflation. All procedure episodes were split into 2 cohorts; those with a hierarchical condition category (HCC) risk score ≥1.5, and those with patient HCC risk scores <1.5. Reimbursement rates were compared between groups.

Results

From 2013 to 2020, a total of 624,077 meniscal debridement procedures and 567,794 arthroscopic rotator cuff repairs were billed to Medicare Part B. During this time, the mean adjusted surgeon reimbursement for arthroscopic rotator cuff repair decreased by 9.2% from 2013 to 2020. During the same time period, the adjusted mean surgeon reimbursement for arthroscopic both compartment meniscal debridement and single compartment meniscal debridement decreased by 7.9% and 9.9%, respectively. Throughout the study period, the mean HCC risk score increased from 1.19 in 2013 to 1.31 in 2020 (P < .001). Across all years in the study, the sicker cohort had a significantly greater rate of all comorbidities and a greater mean body mass index (P < .001 for all variables). The mean reimbursement across this cohort was lower for both rotator cuff repair (P = .037) and meniscal debridement procedures (P < .001) compared with the healthier cohort.

Conclusions

This study demonstrates that from 2013 to 2020, inflation-adjusted surgeon reimbursement for arthroscopic rotator cuff repair and meniscal debridement decreased while patient complexity increased. Further, mean surgeon reimbursement was lower among patients with more complexity in comparison with their healthier counterparts for such procedures.