Decreasing Trend in Medicare Physician Reimbursements for Flap and Microvascular Surgery Procedures From 2002 to 2023.

Purpose: This study aimed to evaluate how major US health care policy changes have influenced long-term Medicare reimbursement trends for upper-extremity flap and microvascular procedures from 2002 to 2023.

Methods: Reimbursement data for 28 common flap and microvascular procedures were extracted from the Medicare Physician Fee Schedule database using Current Procedural Terminology codes. Adjustments for inflation were made using the Consumer Price Index. Statistical analyses included descriptive evaluations, trend analyses, and compound annual growth rate calculations. Sensitivity analyses were performed across four policy-relevant time periods.

Results: From 2002 to 2023, inflation-adjusted Medicare reimbursement amounts for flap and microvascular procedures declined by an average of 36.9%. The compound annual growth rate was -2.3%, and inflation-adjusted reimbursements saw a sharper decline of 4.5% annually. Work relative value units increased modestly by 7.2%, whereas facility and malpractice relative value units increased by 15.9% and 95.7%, respectively. The steepest declines in reimbursement occurred during the COVID-19 pandemic (2020-2023), with an average decrease of 17.1%. Linear regression analyses revealed statistically significant downward trends for all procedures.

Conclusions: Medicare reimbursement amounts for upper-extremity flap and microvascular procedures have not kept pace with inflation, reflecting a broader trend of declining economic viability in surgical subspecialties.

Clinical relevance: This trend may exacerbate disparities in health care access, as physicians face increasing financial pressures. Policymakers must address these challenges to ensure sustainable compensation and equitable care for patients. Future research should explore strategies to mitigate the impact of declining reimbursement rates on patient care and provider practice patterns.